Al-Araji, Sarmad;
Moccia, Marcello;
Bianchi, Alessia;
Yam, Charmaine;
Hamed, Weaam;
Mohamud, Suraya;
Thompson, Alan J;
... Ciccarelli, Olga; + view all
(2025)
Real-World Comparison of High-Efficacy Versus Non-High-Efficacy Therapies in Multiple Sclerosis.
Annals of Clinical and Translational Neurology
, 12
(10)
pp. 2077-2085.
10.1002/acn3.70130.
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Abstract
Objective: The choice of the first disease modifying treatment (DMT) in multiple sclerosis (MS) is a topic of great interest, and whether high-efficacy DMTs should be the first choice remains debated. We compared treatment outcomes (no evidence of disease activity [NEDA] and its components) between treatment-naïve relapsing–remitting MS (RRMS) patients commencing high-efficacy therapies (HET) and non-high-efficacy therapies (non-HET), using propensity score matching. Methods: This is an observational prospective study of two real-world, single-centre, longitudinal cohorts: (1) Relapsing–remitting MS (RRMS) patients initiated dimethyl fumarate, fingolimod, glatiramer acetate and natalizumab between 2002 and 2020; (2) RRMS patients initiated ocrelizumab between 2019 and 2021. We selected treatment-naïve patients and had at least 2 years of follow-up. We compared the two groups at years 1 and 2 using Cox and Logistic regression models as appropriate. Results: After propensity score matching, we included 448 patients: 110 HET and 338 non-HET. The probability of losing NEDA was 57% and 39% lower in the HET group at year 1 and 2 (HR = 0.43; 95% CI = 0.35, 0.52; p < 0.01 and HR = 0.61; 95% CI = 0.45, 0.84; p < 0.01, respectively). The probability of relapse in the HET group was 94% and 71% lower at year 1 and 2 (OR = 0.06; 95% CI = 0.01, 0.28; p < 0.01 and OR = 0.29; 95% CI = 0.10, 0.84; p < 0.02, respectively). The EDSS in the HET group was 30% and 18% lower at year 1 and 2 (Coeff = −0.30; 95% CI = −0.42, −0.18; p < 0.01 and Coeff = −0.16; 95% CI = −0.34, 0.02; p < 0.09, respectively). The probability of MRI activity in the HET group was 82% lower at year 1 (OR = 0.18; 95% CI = 0.04, 0.86; p < 0.03). Interpretation: This study demonstrated that treatment-naïve RRMS patients should be considered for high-efficacy therapies based on a greater suppression of disease activity at 2 years.
| Type: | Article |
|---|---|
| Title: | Real-World Comparison of High-Efficacy Versus Non-High-Efficacy Therapies in Multiple Sclerosis |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/acn3.70130 |
| Publisher version: | https://doi.org/10.1002/acn3.70130 |
| Language: | English |
| Additional information: | © 2025 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Neurosciences, Neurosciences & Neurology, high efficacy therapies, multiple sclerosis, real-world comparison, DISEASE-MODIFYING THERAPY, FINGOLIMOD, NATALIZUMAB, GUIDELINE |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Neuroinflammation |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10216254 |
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