2 common MS treatments show equal benefit in late-onset disease
Anti-CD20, S1P receptor modulators similar in real-world study
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A balance scale stands empty. (Photo by iStock)
- For late-onset MS, anti-CD20 and S1P receptor modulators show similar effectiveness.
- Anti-CD20 therapies might offer more benefit for earlier-onset, less disabled patients.
- Anti-CD20 therapies were associated with serious infections in six cases.
Two commonly used disease-modifying treatments seem to be equally effective for most people with late-onset multiple sclerosis (LOMS), according to a real-world analysis.
Anti-CD20 therapies, designed to reduce immune cells that produce disease-driving antibodies, and S1P receptor modulators, which work by preventing pro-inflammatory immune cells from reaching the brain, showed similar benefits across measures of disease activity and disability progression.
But exploratory analyses suggested that anti-CD20 therapies may offer a modest benefit in patients with earlier disease onset, shorter disease duration, and lower initial disability.
“These findings suggest that both therapies are effective for most people with late-onset MS, but that starting anti-CD20 treatment early may be beneficial for selected patients,” the researchers wrote. “This information can help doctors personalise treatment plans for older adults living with MS.”
The study, “Comparative effectiveness of anti-CD20 therapies and S1P receptor modulators in late-onset multiple sclerosis: real-world evidence from the MSBase registry,” was published in Therapeutic Advances in Neurological Disorders.
Differences emerge when disease is diagnosed later
LOMS (when symptoms emerge after age 50) used to be considered rare, but it’s becoming more commonly diagnosed, accounting for roughly one in 10 new MS cases. Better MRI technology, updated diagnostic guidelines, and greater awareness among doctors have all helped identify MS in older adults.
Still, MS that starts later in life tends to behave differently than when it’s diagnosed at a younger age. LOMS patients are more likely to have a progressive disease course and accumulate disability more quickly. At the same time, disease-modifying therapies are somewhat less effective and more likely to cause side effects in older patients.
Despite these differences, little research has directly compared specific MS medications in people with LOMS.
To address that, scientists from multiple nations came together to compare the two common therapies.
The team gathered real-world data on 447 adults with relapsing-remitting MS enrolled in the international MS registry MSBase whose symptoms had started after the age of 50. All had received one of these therapies for at least six months and had completed at least two disability assessments using the Expanded Disability Status Scale (EDSS).
Results showed that both treatment groups had similarly low relapse rates, with patients on S1P modulators having a mean of 0.05 relapses per year of follow-up and those on CD20 inhibitors having 0.03 relapses per year.
Disability progression was also similar between the two groups. Some 15%-20% of patients in each group experienced confirmed disability worsening — defined as a sustained increase in EDSS scores that lasts at least six months — and both groups reached CDW at around the same time, at a median of 18 months into follow-up.
Other measures of disability worsening, including progression that occurred independently of relapse activity (PIRA) or progression independent of relapse activity with no MRI activity (PIRMA), were also assessed. A similar proportion of patients in each treatment group experienced at least one of these events, and the time to a first event was similar between groups.
As an exploratory step, researchers used machine learning, a type of artificial intelligence that uses algorithms to identify patterns in data. Here, anti-CD20 therapies performed significantly better than S1P modulators at reducing CDW and PIRA in patients diagnosed within two years.
Likewise, anti-CD20 therapies seemed to provide greater benefit to patients who had lower disability levels at the start of treatment, as well as those who were on the younger end of the late-onset spectrum (diagnosed at age 50-55).
The team said the machine-learning findings “should be considered hypothesis-generating and interpreted with caution.”
Six cases of serious infections occurred in patients taking anti-CD20 therapies. No serious infections were observed among patients receiving S1P receptor modulators.
“In this real-world study of LOMS, we did not observe statistically significant differences in relapse or disability outcomes between anti-CD20 therapies and S1P receptor modulators,” the team concluded. “Exploratory analyses suggested anti-CD20 may be associated with better outcomes in selected subgroups.”
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