For people recently diagnosed with multiple sclerosis, early treatment choices were linked to only slight differences after two years, based on the first treatment they used, according to a new study. The study does not prove that one treatment strategy causes better outcomes than another; it only shows associations.
 

Briefly:
Study of 509 people newly diagnosed with MS found only small differences after two years, based on the first treatment they used.
People taking B-cell treatments had fewer MS attacks and a small drop in MRI lesions compared with people taking oral platform treatments.
After two years, researchers did not find differences between the treatment groups in disability scores or blood signs of nerve damage.
The study does not prove that one treatment causes better outcomes than another; it only shows an association.

The study, led by researchers in Karolinska Institutet in Stockholm, Sweden, found B-cell-depleting therapies – which are given through an infusion in a vein and lower the number of B cells, a type of immune cell that can play a role in MS – were linked to lower relapse rates and reduced MRI lesion volume compared with oral therapies. While some treatments were linked to fewer relapses and MRI changes, researchers found no differences in disability scores after two years. 

The study involved 509 people with an average age of 33 who were newly diagnosed with relapsing or progressive MS and had not previously received disease-modifying therapy. Participants were followed for two years. Participants were grouped by the first treatment they started within six months of the start of the study: 17 percent received injectable platform therapies; 30 percent received oral platform therapies; 16 percent received high-efficacy therapies, or stronger MS treatments used when doctors want to control disease activity more aggressively; 20 percent received B-cell–depleting therapies; and 18 percent received no treatment.

B-cell–depleting therapies included rituximab and ocrelizumab. High-efficacy therapies included fingolimod, cladribine, natalizumab and alemtuzumab. Oral platform therapies included dimethyl fumarate and teriflunomide. Injectable platform therapies included interferon-beta and glatiramer acetate.

Researchers looked at relapse rate, change in MRI lesion volume and blood levels of serum neurofilament light chain, a biomarker of nerve cell injury. They also looked at another biomarker called serum glial fibrillary acidic protein, change in disability scores and whether participants remained on their initial therapy at two years.

The relapse rate was lowest among people taking B-cell-depleting therapies, at 0.04 relapses per year on average, compared with 0.16 for people taking oral platform therapies. After adjusting for factors such as age, sex and disease duration, people taking B-cell-depleting therapies had a 62 percent lower relapse rate than those taking oral platform therapies. They did not find an association between high-efficacy therapies and relapse rate.

For MRI findings, B-cell-depleting therapies were linked to a slight reduction in lesion volume, a measure of disease-related brain lesions, compared with oral platform therapies. A similar trend was observed with other high-efficacy therapies, but the difference was not statistically significant.

People taking B-cell treatments were most likely to stay on their first treatment. After two years, 94 percent of people in this group were still taking it. This compared with 87 percent of people taking high-efficacy therapies, 72 percent taking oral platform treatments, 63 percent who were not treated and 61 percent taking injectable platform treatments.

However, researchers found no differences between treatment groups in disability score changes at two years. They also found no differences between treatment groups in serum neurofilament light chain levels at two years.

A limitation of the study was that people were not randomly put into treatment groups, so the results may have been affected by which treatment they chose.

The findings were published in the journal Neurology.