B-cell therapies linked to fewer relapses in early MS, study finds
Two-year European study found no significant differences in disability changes
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A European study found that B-cell-depleting therapies were associated with fewer relapses and reduced brain lesion volume in people newly diagnosed with multiple sclerosis, but no significant differences in disability changes were observed over two years. (Image by iStock)
- Among people newly diagnosed with multiple sclerosis, B-cell-depleting treatments were associated with significantly lower relapse rates and greater reductions in brain lesion volume compared with oral therapies.
- Despite differences in relapse rates and brain lesion volume, changes in disability scores were similar across treatment groups over two years.
- Longer follow-up is needed to determine whether differences in early disease activity lead to meaningful reductions in long-term disability.
In a European study of people newly diagnosed with multiple sclerosis (MS), B-cell-depleting treatments were linked to fewer relapses and greater reductions in brain lesion volume over two years compared with oral treatments. However, changes in disability scores were similar across treatment groups.
The findings suggest that early treatment choices may be linked to differences in MS-related inflammation. However, longer follow-up is needed to determine whether these differences lead to meaningful benefits over time.
Early MS treatment decisions depend on individual needs
“These findings may help doctors and people with MS talk about what to expect from early treatment,” said Fredrik Piehl, MD, PhD, a professor at Karolinska Institutet in Stockholm, Sweden, who co-led the study, in an American Academy of Neurology (AAN) press release. “No single treatment will be the best choice for everyone, and patient characteristics need to be considered when selecting therapy.”
The study, “Therapy Choices and Outcomes in Newly Diagnosed Multiple Sclerosis: The Pan-European MultipleMS Study,” was published in Neurology Open Access, a journal of the AAN.
MS develops when the immune system mistakenly attacks the protective covering around nerve fibers in the brain and spinal cord. The resulting damage can cause relapses, when new symptoms appear or existing ones worsen. Over time, this damage can contribute to disability.
Disease-modifying treatments (DMTs) can reduce relapses and help limit disability that develops when a person does not fully recover from an attack. However, disability can also worsen gradually without relapses, and existing MS treatments are less effective at slowing this type of progression.
Studies have shown that starting highly effective DMTs early can help limit long-term disability. However, more evidence from routine clinical care is needed to understand how different types of treatment compare in people newly diagnosed with MS.
To compare treatment outcomes, European researchers conducted the MultipleMS study, which followed 509 adults who had been diagnosed with MS within the previous two years and had never received a DMT. The observational study followed patients without randomly assigning treatments. Participants had an average age of 33, and 89.4% completed the two-year follow-up.
Researchers compare five approaches to early MS treatment
Participants were placed into five groups based on whether they started treatment within six months of joining the study and which treatment they received. A total of 87 received injectable therapies, including interferon-beta treatments and glatiramer acetate (sold as Copaxone, among others). Another 152 received oral therapies, including Tecfidera (dimethyl fumarate) and Aubagio (teriflunomide).
Another 79 participants received treatments classified as high efficacy in the study: Gilenya (fingolimod), Mavenclad (cladribine), Tysabri (natalizumab), and Lemtrada (alemtuzumab). Another 101 participants received B-cell-depleting treatments, including rituximab and Ocrevus (ocrelizumab). The remaining 90 had not started treatment within the first six months, although some began treatment later.
Participants in the B-cell-depleting group had the lowest relapse rate, averaging 0.04 relapses per year, compared with 0.16 among those in the oral treatment group. Even after researchers accounted for differences in factors such as age, sex, disease duration, and initial disease activity, B-cell-depleting treatments were associated with a 62% lower relapse rate than oral treatments.
Participants in the other high-efficacy treatment group also had a lower average relapse rate than those receiving oral treatments — 0.11 versus 0.16 relapses per year. However, the difference was not statistically significant after researchers adjusted for other factors.
Brain MRI scans also showed that B-cell-depleting treatments were associated with a modestly greater reduction in the volume of MS-related lesions compared with oral treatments. Other high-efficacy treatments showed a similar trend, but the difference was not statistically significant.
In an accompanying editorial published in Neurology Open Access, Carmen Tur, MD, PhD, a researcher affiliated with University College London in the U.K. and the Vall d’Hebron Institute of Research in Barcelona, Spain, wrote that “this study provides real-world evidence that two-year outcomes differ only modestly across initial DMT choices in early MS.”
Despite differences in relapse rates and MRI findings, researchers found no significant differences between treatment groups in changes in disability scores, as measured by the Expanded Disability Status Scale (EDSS).
The findings suggest that better control of MS-related inflammation was not accompanied by clear differences in disability changes over the two-year study. However, longer follow-up is needed to determine whether these differences in disease activity affect disability over time.
“The long-term clinical implications of these findings will require extended follow-up within MultipleMS and other studies,” the researchers concluded.
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