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Review
. 2022 Dec;36(12):1285-1299.
doi: 10.1007/s40263-022-00965-7. Epub 2022 Nov 9.

High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis

Léorah Freeman  1 , Erin E Longbrake  2 , Patricia K Coyle  3 , Barry Hendin  4 , Timothy Vollmer  5
Affiliations
Review

High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis

Léorah Freeman et al. CNS Drugs. 2022 Dec.

Abstract

There are > 18 distinct disease-modifying therapy (DMT) options covering 10 mechanisms of action currently approved by the US Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). Given the multitude of available treatment options, and recent international consensus guidelines offering differing recommendations, there is broad heterogeneity in how the DMTs are used in clinical practice. Choosing a DMT for newly diagnosed patients with MS is currently a topic of significant debate in MS care. Historically, an escalation approach to DMT was used for newly diagnosed patients with RRMS. However, the evidence for clinical benefits of early treatment with high-efficacy therapies (HETs) in this population is emerging. In this review, we provide an overview of the DMT options and MS treatment strategies, and discuss the clinical benefits of HETs (including ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine) in the early stages of MS, along with safety concerns associated with these DMTs. By minimizing the accumulation of neurological damage early in the disease course, early treatment with HETs may enhance long-term clinical outcomes over the lifetime of the patient.

Plain language summary

Disease-modifying therapies (DMTs) can help people with multiple sclerosis (MS) by changing the way that their MS develops over time. Some people with MS have relapses when their symptoms get worse, followed by recovery when their MS is remitting. This is called relapsing–remitting MS (RRMS). DMTs can reduce both the number and the severity of relapses. They can also delay the nerve damage that relapses cause. A range of DMTs are approved for treating people with RRMS. These treatments work in different ways, and international treatment guidelines vary on their recommendations for using DMTs in the clinic. Selecting DMTs for people with newly diagnosed RRMS is still a topic of discussion. Previously, people with RRMS only received the more effective high-efficacy therapies (HETs) if their first treatment was not effective. HETs include ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine. Recently, using HETs at an earlier stage has shown promising results. In this review article, we provide an overview of the clinical strategies and the DMT options that are available for people with MS. Additionally, we discuss the benefits of using HETs for people with newly diagnosed MS and consider the safety issues related to DMTs. We summarize that using HETs to reduce the buildup of nerve damage during the early stages of MS may lead to improved long-term clinical outcomes over a person’s lifetime.

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Conflict of interest statement

Léorah Freeman has received consultancy fees from Celgene/Bristol Myers Squibb, EMD Serono, Genentech, Novartis, and TG Therapeutics; and has received program sponsorship from EMD Serono. She has grant support from EMD Serono, Genentech, NIH/NINDS, and PCORI. Erin E. Longbrake has received honoraria from Bristol Myers Squibb, Genentech, Janssen, NGM Bio, and TG Therapeutics. She has research support from Genentech, NIH K23NS107624, Race to Erase MS, and

UL1 TR001863. Patricia K. Coyle received consultancy fees from Accordant, Alexion, Bayer, Biogen, Bristol Myers Squibb, Celgene, EMD Serono, Genentech/Roche, GlaxoSmithKline, Horizon Therapeutics, Janssen, Mylan, Novartis, Sanofi Genzyme, TG Therapeutics, and Viela Bio; and has received research grants from Actelion, Alkermes, Corrona, Genentech/Roche, MedDay, NINDS, and Novartis. Barry Hendin has received research support and advisory and speaking honoraria from Alexion, Biogen, EMD Serono, Genentech, Genzyme, and Novartis. Timothy Vollmer has received compensation for lectures and consultancy from Biogen, Celgene, EMD Serono, Genentech/Roche, Novartis, and Siranax; and has received research support from Anokion, Biogen, Celgene, F. Hoffmann-La Roche Ltd., Genentech, GW Pharma, Rocky Mountain Multiple Sclerosis Center, and TG Therapeutics.

Figures

Fig. 1
Fig. 1
Natural history of MS. Gd gadolinium, MRI magnetic resonance imaging, MS multiple sclerosis, PPMS primary progressive multiple sclerosis, RRMS relapsing–remitting multiple sclerosis, SPMS secondary progressive multiple sclerosis
See this image and copyright information in PMC

References

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    1. European Multiple Sclerosis Platform. MS treatments. https://emsp.org/about-ms/ms-treatments/. Accessed 29 July 2022.

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