scholarly journals Sequencing of high-efficacy disease-modifying therapies in multiple sclerosis: perspectives and approaches

2018 ◽  
Vol 13 (11) ◽  
pp. 1871 ◽  
Author(s):  
Francois Grand′Maison ◽  
Michael Yeung ◽  
SarahA Morrow ◽  
Liesly Lee ◽  
Francois Emond ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
Disease Modifying

Initial high-efficacy disease-modifying therapy in multiple sclerosis

Neurology ◽  
2020 ◽  
Vol 95 (8) ◽  
pp. e1041-e1051 ◽  
Author(s):  
Mathias Due Buron ◽  
Thor Ameri Chalmer ◽  
Finn Sellebjerg ◽  
Ismael Barzinji ◽  
Jeppe Romme Christensen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lower Probability ◽  
Matched Sample ◽  
Class Iii ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
Baseline Activity ◽  
First Relapse ◽  
Disease Modifying ◽  
Edss Score

ObjectiveTo determine the effectiveness of high-efficacy disease-modifying therapies (heDMTs) vs medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naive patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry.MethodsWe identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity score matched sample of patients starting meDMT.ResultsWe included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval [CI] 10.4%–23.0%) and 30.1% (95% CI 23.1%–37.1%) for heDMT and meDMT initiators, respectively (hazard ratio [HR] 0.53, 95% CI 0.33–0.83, p = 0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37–0.67). Results were similar after pairwise censoring and in subgroups with high baseline activity, diagnosis after 2006, or information on baseline T2 lesion load.ConclusionWe found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT.Classification of evidenceThis study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.

Identification of patients with relapsing multiple sclerosis eligible for high-efficacy therapies

2021 ◽  
Author(s):  
José Meca-Lallana ◽  
Juan Antonio García-Merino ◽  
Sergio Martínez-Yélamos ◽  
Angela Vidal-Jordana ◽  
Lucienne Costa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Expert Opinion ◽  
Second Line ◽  
High Efficacy ◽  
Clinical Evolution ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Relapsing Multiple Sclerosis ◽  
Selection Of

Relapsing multiple sclerosis (RMS) presents a highly variable clinical evolution among patients, and its management should be personalized. Although there is no cure at present, effective disease-modifying therapies (DMTs) are available. Selection of the most appropriate DMT for each patient is influenced by several clinical, radiological and demographic aspects as well as personal preferences that, at times, are not covered in the regulatory criteria. This may be a source of difficulty, especially in certain situations where so-called ‘high-efficacy DMTs’ (usually considered second-line) could be of greater benefit to the patient. In this narrative review, we discuss evidence and experience, and propose a pragmatic guidance on decision-making with respect to the indication and management of high-efficacy DMT in adult patients with RMS based on expert opinion.

scholarly journals Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies

2021 ◽  
Vol 14 ◽  
pp. 175628642110128
Author(s):  
Anat Achiron ◽  
Mathilda Mandel ◽  
Sapir Dreyer-Alster ◽  
Gil Harari ◽  
David Magalashvili ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Immune Response ◽  
Humoral Immunity ◽  
Lymphocyte Count ◽  
Healthy Subjects ◽  
Vaccine Dose ◽  
Humoral Response ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
Disease Modifying

Background and Aims: The National Multiple Sclerosis Society and other expert organizations recommended that all patients with multiple sclerosis (MS) should be vaccinated against COVID-19. However, the effect of disease-modifying therapies (DMTs) on the efficacy to mount an appropriate immune response is unknown. We aimed to characterize humoral immunity in mRNA-COVID-19 MS vaccinees treated with high-efficacy DMTs. Methods: We measured SARS-CoV-2 IgG response using anti-spike protein-based serology (EUROIMMUN) in 125 MS patients vaccinated with BNT162b2-COVID-19 vaccine 1 month after the second dose. Patients were either untreated or under treatment with fingolimod, cladribine, or ocrelizumab. A group of healthy subjects similarly vaccinated served as control. The percent of subjects that developed protective antibodies, the titer, and the time from the last dosing were evaluated. Results: Protective humoral immunity of 97.9%, 100%, 100%, 22.7%, and 3.8%, was observed in COVID-19 vaccinated healthy subjects ( N = 47), untreated MS patients ( N = 32), and MS patients treated with cladribine ( N = 23), ocrelizumab ( N = 44), and fingolimod ( N = 26), respectively. SARS-CoV-2 IgG antibody titer was high in healthy subjects, untreated MS patients, and MS patients under cladribine treatment, within 29.5–55 days after the second vaccine dose. Only 22.7% of patients treated with ocrelizumab developed humoral IgG response irrespective to normal absolute lymphocyte count. Most fingolimod-treated MS patients had very low lymphocyte count and failed to develop SARS-COV-2 antibodies. Age, disease duration, and time from the last dosing did not affect humoral response to COVID-19 vaccination. Conclusions: Cladribine treatment does not impair humoral response to COVID-19 vaccination. We recommend postponing ocrelizumab treatment in MS patients willing to be vaccinated as a protective humoral response can be expected only in some. We do not recommend vaccinating MS patients treated with fingolimod as a protective humoral response is not expected.

timing of high-efficacy disease modifying therapies for relapsing-remitting multiple sclerosis

2017 ◽  
Vol 88 (5) ◽  
pp. e1.11-e1
Author(s):  
Bernd Merkel ◽  
Vilija Jokubaitis ◽  
Tim Spelman ◽  
Jeannette Lechner-Scott ◽  
Pamela McCombe ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

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

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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