Results from a Canadian study show a survival advantage with early treatment of first- and second-generation disease-modifying therapies (DMTs) in people with multiple sclerosis (MS).
DMTs for MS target underlying disease processes, such as inflammation, and have been previously associated with improved clinical outcomes in people living with MS, including lower risk of disease activity and progression. However, the longer-term effect of DMTs on survival in people with MS in the real-world, outside of clinical trials, is not well understood.
In this study, Dr. Helen Tremlett and team from the University of British Columbia determined whether there is an association between exposure to first- and second-generation DMTs and reduction in mortality in people with MS, compared to no or minimal exposure. Administrative health databases from 4 Canadian provinces (British Columbia, Saskatchewan, Manitoba, and Nova Scotia) spanning over 20 years (between 1996-2017) and representing 25% of Canada’s population, were examined. A total of 35, 894 people with MS were identified. First generation DMTs, beta-interferon and glatiramer acetate, were found to be the most used DMTs among the cohort, while second generation DMTs were less commonly used and included natalizumab, fingolimod, dimethyl fumarate, teriflunomide, alemtuzumab and ocrelizumab.
Results found that exposure to any DMT, first- or second-generation DMT, is associated with a 26-33% lower risk of mortality, compared to no DMT exposure in people with MS. Additionally, very early initiation of beta-interferon and glatiramer acetate as compared to no exposure was associated with a significant reduction in mortality risk. They found that this survival advantage diminished over time and is consistent with the clinical outcomes for these two DMTs and their efficacy on relapse risk, which also diminishes over time. Factors such as lifestyle, disease duration, and disability level and their impact on survival in people living with MS, could not be assessed in this study.
The findings of this study emphasize the importance for clinicians and people with MS to evaluate their treatment options and develop effective treatment plans early in disease onset that will optimize health outcomes and reduce risk of mortality.
To learn more about the available DMTs for persons with MS, visit the MS Society of Canada’s page on Disease-modifying therapies.
The lead author of this study, Dr. Huah Shin Ng, is supported by the MS Society of Canada’s endMS postdoctoral fellowship.
References:
Article published in Neurology, Neuroimmunology, Neuroinflammation – Disease-Modifying Drugs for Multiple Sclerosis and Association with Survival. Link to article – here.