#ECTRIMS2022 – DMTs Ease SPMS Disability Early but Not Over Time

Early use of disease-modifying therapies (DMTs) among people with secondary progressive multiple sclerosis (SPMS) may lead to overall lower levels of disability, according to a new analysis.

But staying on treatment does not appear to significantly slow disability progression over time.

People with SPMS who used DMTs early on consistently had lower scores on the Expanded Disability Status Scale (EDSS) — reflecting less disability — than untreated individuals. However, patients saw similar rates of EDSS increases over time, regardless of treatment status, the researchers found.

The findings, based on data from nine large MS registries, “really stress the importance of earlier recognition and intervention of progressive transition,” said Luigi Pontieri, PhD, a research statistician at the Danish Multiple Sclerosis Registry, in Denmark.

Pontieri discussed the findings in an oral presentation, titled “Influence of DMT on EDSS scores trajectories in treated and not treated patients with SPMS – analysis from nine registries,” at the 38th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held Oct. 26-28 in Amsterdam and virtually.

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Investigating DMTs for SPMS

More than a dozen DMTs are approved in the U.S. for the treatment of MS. These therapies aim to alter the course of the disease, some by preventing relapses, and others by reducing MRI disease activity or slowing disability accumulation.

While a number of DMTs have emerged in recent years for relapsing forms of MS — those marked by periods of symptom exacerbations, or relapses, followed by periods of remission — fewer options are available for SPMS patients. For these individuals, MS symptoms gradually worsen over time, even in the absence of relapses.

Moreover, data is lacking on the impact of available DMTs on disease progression once a patient transitions to SPMS.

To address that knowledge gap, Pontieri and colleagues evaluated the disability trajectories of adult SPMS patients given DMTs relative to patients left untreated.

Data were obtained from nine MS registries involved in the SPMS Research Collaboration Network. These included national registries from the U.K., Denmark, Sweden, the Czech Republic, Germany, Italy, Finland, and France, as well as the international MSBase registry.

Patients were included if they had been diagnosed with SPMS by Jan. 1, 2015, and were at least 18 years old by Jan. 1, 2017 (index date). Each was assigned to either the treated or untreated group.

Participants were listed in the treated group if, from January 2015 to January 2017, they had been on a DMT for at least 80% of the time, and were receiving a DMT at the index date. On the other hand, those who had been on a DMT for 20% or less of that two-year period, and were not receiving treatment at the index date, were deemed untreated.

Disability trajectories were compared between these two groups by evaluating changes in EDSS scores, collected at least once between January 2015 and January 2017, and at least once in a four year follow-up between the index date and January 1, 2021.

Data from individual database were converted to a common format prior to analysis. Overall, 10,238 patients were included across all registries.

As of the index date, untreated patients were older and had a longer disease duration than treated patients across all registries. There also was a greater proportion of untreated patients who hadn’t experienced a disease relapse in the previous year.

Results showed that patients in the treatment group had lower EDSS scores at the index date, reflecting a lower degree of disability, and that these scores tended to remain lower over the course of follow-up.

However, scores generally increased for all patients over time, and the rate of disability progression was not significantly different in treated versus untreated patients. This meant that treated patients had less disability in the earlier stages of their disease, but treatment did not slow the progression of their disease at later stages.

“Non-treated SPMS patients have generally higher EDSS values than treated patients, suggesting a beneficial effect of DMTs in slowing disease accumulation at earlier stages of the progressive phase,” Pontieri said. “However, as patients get older, staying on DMTs does not seem to slow [disability progression].”

“While DMTs might be beneficial in SPMS patients at earlier stage of progression, their effect might fade away as patients get older, stressing the importance of earlier recognition and intervention of progressive transition,” the team concluded.

Note: The Multiple Sclerosis News Today team is providing in-depth coverage of the ECTRIMS Forum 2022 Oct. 26-28. Go here to see the latest stories from the conference.