Early treatment choices for people newly diagnosed with multiple sclerosis (MS) may influence relapse rates and MRI findings, but a two-year study found no clear differences in disability outcomes between treatment groups.
The study, published in Neurology Open Access, followed 509 people with newly diagnosed relapsing or progressive MS who had not previously received disease-modifying therapy. Participants had an average age of 33 and were followed for two years.
Participants were grouped according to their first treatment. These included injectable and oral platform therapies, high-efficacy treatments, B-cell-depleting therapies, or no treatment.
The strongest differences were seen among people receiving B-cell-depleting therapies, including rituximab and ocrelizumab. This group had an average relapse rate of 0.04 per year, compared with 0.16 among those receiving oral platform therapies. After adjustment for factors including age, sex and disease duration, B-cell treatment was associated with a 62% lower relapse rate.
B-cell-depleting treatment was also associated with a small reduction in MRI lesion volume compared with oral platform therapies. Other high-efficacy treatments showed a similar trend, although the difference was not statistically significant.
Treatment persistence also differed. After two years, 94% of people receiving B-cell therapies remained on their initial treatment, compared with 87% receiving high-efficacy therapies, 72% taking oral platform treatments and 61% taking injectable platform therapies.
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However, researchers found no differences between treatment groups in disability score changes or blood levels of serum neurofilament light chain, a marker of nerve cell injury. The findings therefore suggest that early treatment differences may be more apparent in inflammatory disease activity than in disability over the first two years.
The researchers emphasised that treatment decisions should be individualised. Because participants were not randomly assigned to treatments, the study cannot establish that one treatment causes better outcomes. Longer follow-up will be needed to determine whether differences in relapse and MRI activity translate into differences in disability over time.
This news item has been summarised using AI and checked by humans before publication.
Sources
American Academy of Neurology via Newswise
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