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. 2022 May 26;29(9):2761-2771.
doi: 10.1111/ene.15422. Online ahead of print.

Disability Progression in Multiple Sclerosis Patients using Early First-line Treatments

Mathilde Lefort  1   2 , Sandra Vukusic  3   4   5   6 , Romain Casey  3   4   5   6 , Gilles Edan  2   7 , Emmanuelle Leray  1   2 ; OFSEP investigators
Collaborators, Affiliations

Disability Progression in Multiple Sclerosis Patients using Early First-line Treatments

Mathilde Lefort et al. Eur J Neurol. .

Abstract

Background: Therapeutic management of relapsing-remitting multiple sclerosis (RRMS) has evolved towards early treatment. The objective was to assess the impact of early treatment initiation on disability progression among RRMS first-line treated patients.

Methods: This study included all incident RRMS cases starting interferon or glatiramer acetate for the first time from 1996/01/01 to 2012/31/12 (N=5,279) from ten MS expert OFSEP centers (Observatoire Français de la Sclérose en Plaques). The delay from treatment start to attain an irreversible Expanded Disability Status Scale score of 3.0 were compared between "Early" group (N= 1,882; treated within 12 months following MS clinical onset) and "Later" group using propensity score weighted Kaplan-Meier methods, overall and stratified by age.

Results: Overall, the restricted mean time before reaching EDSS 3.0 (RMST) from treatment start was 11 years and two months for patients treated within the year following MS clinical onset and 10 years and seven months for patients treated later. Thus, early treated patients gained 7 months (95% CI: [4-11] months) in the time to reach EDSS 3.0 compared to patients treated later (treatment start delayed by 28 months). The difference in RMST was respectively six months (95% CI: [1-10] months) and 14 months (95% CI: [4-24] months) in the "≤40 years" age group and in the ">40 years" age group, in favour of early group. .

Conclusions: Early treatment initiation resulted in a significant reduction of disability progression among patients with RRMS, and also among older patients.

Keywords: beta-interferon; disability progression; early treatment; glatiramer acetate; multiple sclerosis; observational studies; propensity score.

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Conflict of interest statement

M. Lefort reports that she had travel grants from Roche SAS. S. Vukusic reports that she had consulting and lecturing fees, travel grants and unconditional research support from Biogen, Celgène, Geneuro, Genzyme, MedDay, Merck Serono, Novartis, Roche, Sanofi Aventis and Teva Pharma. R. Casey reports that he had no conflict of interest. G. Edan reports that he had personal honoraria for lectures or consulting from Bayer, Biogen, LFB, Merck, Novartis, Roche, Sanofi; research support from Bayer, Biogen, Genzyme, Merck, Novartis, Roche and Teva Pharma. E. Leray reports that she had consulting and lecture fees or travel grants from Biogen, Genzyme, MedDay Pharmaceuticals, Merck Serono, Novartis, Sanofi Aventis and Roche.

Figures

FIGURE 1
FIGURE 1
Study flowchart to assess the disability progression in multiple sclerosis (MS) patients using early first‐line treatment
FIGURE 2
FIGURE 2
Percentage of multiple sclerosis (MS) patients treated early (defined as an initiation within the year following MS clinical onset) according to year of MS clinical onset
FIGURE 3
FIGURE 3
Kaplan–Meier estimates of the time before reaching an EDSS score of 3.0 from treatment start for multiple sclerosis (MS) patients treated by a first‐line treatment as an initial treatment within the year following MS clinical onset (early) or later (late), according to two propensity score models
FIGURE 4
FIGURE 4
Kaplan–Meier estimates of the time before reaching an EDSS score of 3.0 from treatment start for multiple sclerosis (MS) patients treated by a first‐line treatment as initial treatment within the year following MS clinical onset (early) or later (late), according to propensity score models and stratified by age at MS clinical onset
FIGURE 5
FIGURE 5
Estimated hazard ratio (HR) of early treatment initiation effect on attainment of EDSS 3.0 in multiple sclerosis (MS) patients: overall, according to age at MS clinical onset, and in the sensitivity analysis from two propensity score (PS) models
See this image and copyright information in PMC

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