PND1 IMPACT of EARLY Disease Modifying Therapy (DMT) Treatment Initiation and Use of High-Efficacy (HET) on Clinical and Health Outcomes in Patients with Multiple Sclerosis (MS)

Alemtuzumab is a high-efficacy disease-modifying therapy for the treatment of relapsing forms of multiple sclerosis and is associated with secondary autoimmune adverse events. We report a novel case of secondary autoimmune myositis that occurred seven months after the initial treatment cycle and achieved full recovery with oral corticosteroids. This particular form of myositis appears to be unique, and is likely to be a distinct entity from the other four types of immune-mediated myositis.

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Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211019574 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110195

Author(s):

Pietro Iaffaldano ◽

Giuseppe Lucisano ◽

Francesca Caputo ◽

Damiano Paolicelli ◽

Francesco Patti ◽

...

Keyword(s):

Multiple Sclerosis ◽

Repeated Measures ◽

Treatment Strategies ◽

Study Cohort ◽

High Efficacy ◽

Disease Modifying Therapy ◽

The Mean ◽

Disease Modifying ◽

Late Start ◽

Multiple Sclerosis Patients

Background and aims: No consensus exists on how aggressively to treat relapsing–remitting multiple sclerosis (RRMS) nor on the timing of the treatment. The objective of this study was to evaluate disability trajectories in RRMS patients treated with an early intensive treatment (EIT) or with a moderate-efficacy treatment followed by escalation to higher-efficacy disease modifying therapy (ESC). Methods: RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the Italian MS Registry. EIT group included patients who received as first DMT fingolimod, natalizumab, mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients received the high efficacy DMT after ⩾1 year of glatiramer acetate, interferons, azathioprine, teriflunomide or dimethylfumarate treatment. Patients were 1:1 propensity score (PS) matched for characteristics at the first DMT. The disability trajectories were evaluated by applying a longitudinal model for repeated measures. The effect of early versus late start of high-efficacy DMT was assessed by the mean annual Expanded Disability Status Scale (EDSS) changes compared with baseline values (delta-EDSS) in EIT and ESC groups. Results: The study cohort included 2702 RRMS patients. The PS matching procedure produced 363 pairs, followed for a median (interquartile range) of 8.5 (6.5–11.7) years. Mean annual delta-EDSS values were all significantly ( p < 0.02) higher in the ESC group compared with the EIT group. In particular, the mean delta-EDSS differences between the two groups tended to increase from 0.1 (0.01–0.19, p = 0.03) at 1 year to 0.30 (0.07–0.53, p = 0.009) at 5 years and to 0.67 (0.31–1.03, p = 0.0003) at 10 years. Conclusion: Our results indicate that EIT strategy is more effective than ESC strategy in controlling disability progression over time.

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Early and unrestricted access to high-efficacy disease-modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis

Journal of Neurology ◽

10.1007/s00415-021-10836-8 ◽

2021 ◽

Author(s):

Massimo Filippi ◽

Romano Danesi ◽

Tobias Derfuss ◽

Martin Duddy ◽

Paolo Gallo ◽

...

Keyword(s):

Multiple Sclerosis ◽

Healthcare Systems ◽

High Efficacy ◽

Disease Modifying Therapy ◽

Disease Modifying Therapies ◽

Appropriate Treatment ◽

European Healthcare ◽

Efficient Resource ◽

Unrestricted Access ◽

Disease Modifying

AbstractEarly intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit–risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.

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