« on: April 08, 2020, 09:59:21 pm »
From NEJM Neurology (April 7, 2020), "Early vs. Late High-Efficacy Therapy in Multiple Sclerosis"--Summary and Comment:
Early vs. Late High-Efficacy Therapy in Multiple SclerosisRobert T. Naismith, MD reviewing He A et al. Lancet Neurol 2020 AprEarly aggressive treatment had benefits 6 to 10 years after disease onset.Selecting multiple sclerosis (MS) therapies is an exercise in balancing benefits and risks. Early treatment with high-efficacy agents is hypothesized to lead to improved long-term outcomes, although more direct evidence is needed. Investigators have now used two distinct registries to evaluate patients on high-efficacy therapy with complete data from diagnosis to at least 6 years. High-efficacy therapies included rituximab, ocrelizumab, alemtuzumab, mitoxantrone, and natalizumab.
The investigators propensity-matched the early high-efficacy treatment group (i.e., those with treatment initiated within 2 years of symptom onset) to the late-treatment group (initiated 4–6 years after onset), resulting in 213 early treated patients and 253 late-treated patients. From 6 through 10 years after disease onset, when all patients were on high-efficacy therapy, the mean Expanded Disability Status Scale (EDSS) score was 1 point lower in the early versus the late treatment group and confirmed disability worsening remained less common in the early start group (hazard ratio, 0.38; 95% CI, 0.17–0.81).COMMENTThe window of therapeutic opportunity refers to the first 5 years of the disease, when inflammation is highest (NEJM JW Neurol Mar 2019 and JAMA 2019; 321:175). While we wait for randomized, controlled studies, these observational findings add to the evidence that high-efficacy agents, when begun early, may have long-term benefits. Benefits for early high-efficacy treatment seemed to continue past the time when all patients were on high-efficacy treatment.EDITOR DISCLOSURES AT TIME OF PUBLICATIONDisclosures for Robert T. Naismith, MD at time of publicationConsultant/Advisory Board Alexion; Alkermes; Bayer; Biogen; EMD Serono; Genzyme Corp./Sanofi; Genentech; Novartis; Viela BioGrant/Research Support National Multiple Sclerosis Society; National Institutes of HealthCITATION(S):He A et al. Timing of high-efficacy therapy for multiple sclerosis: A retrospective observational cohort study. Lancet Neurol 2020 Apr; 19:307.
« Last Edit: April 08, 2020, 10:06:59 pm by agate »
MS Speaks--online for 17 years
SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20 - 3/16/24.
Home
Search
Today's Posts
Contact
Login
Register
Topic: Early vs. late high-efficacy therapy in MS (NEJM summary/comment) (Read 61 times)
March 22, 2020, 02:55:01 pm