Around 13,500 people with multiple sclerosis live in Austria. With treatment options that have become increasingly widespread over the past two decades, the question of an optimal long-term strategy arises. A domestic registry study has now demonstrated clear advantages for patients with relapsing forms of MS when using highly effective immunological therapies.
Specialists in neurology from the medical universities in Vienna, Graz and Innsbruck and the university clinics in Linz and Salzburg were involved in the study. The study data came from the Austrian MS Treatment Registry (AMSTR). The question was which drug treatment for relapsing multiple sclerosis after initial therapy with beta-interferon or glatiramer acetate is routinely most effective outside of clinical trials.
The two drugs have been in use since the mid-1990s and in previous studies reduced the MS relapse rate by around a third. Blocking off acute phases and preventing further such crises are the focus of MS therapy, because each flare-up of the disease can be associated with a greater permanent disability.
In the introduction to their study, the authors under Michael Guger (Steyr Hospital and Kepler University Linz) emphasize the further advances in MS therapy after the “platform” substances beta interferon and glatiramer acetate anti-inflammatory drug dimethyl fumarate and teriflunomide, originally used in rheumatism therapy, reduced the annual MS relapse rate by 44 to 53 percent and 32 to 36 percent, respectively, compared to placebo. Both agents are used for the therapy of mild to moderate forms of MS.
therapies in comparison
If there are two or more episodes of the disease per year, one speaks of severe MS. In the past two decades, new principles of action have been developed with highly immunologically active substances such as fingolimod (originally from transplantation medicine), ozanimod, cladribine (chemotherapeutic agent) or the monoclonal antibodies natalizumab, alemtuzumab or ocrelizumab and approved for the treatment of rapidly progressing multiple sclerosis. So far, however, scientific evidence as to which alternatives should be used if the “platform” therapy is not effective has been limited.
In their work, which was published in the Journal of Neurology at the beginning of March, the Austrian experts therefore compared the data of 669 MS patients from the therapy registry who, from 2006 onwards, were treated “horizontally” by interferon beta or glatiramer acetate to treatment with dimethyl fumarate or teriflunomide had switched, with 800 patients who were switched “vertically” to one of the highly active immunological therapies. The results were quite clear: With a “horizontal” change in therapy, there was an average annual relapse rate of 0.39 such episodes. “Vertical” switching to the highly effective therapies reduced the annual relapse rate to less than half (0.17).
Overall, according to one of the statistical evaluations, relapses occurred 86 percent less frequently when switching from basic therapy to demethyl fumarate or teriflunomide compared to the other drugs. Switching to the more effective therapies was also associated with an almost 80 percent reduction in the need for further treatment changes.