Early intervention with a highly effective disease-modifying therapy reduces disability progression in relapsing-remitting MS.
A comparison of two national cohorts with different treatment strategies showed starting with a more effective therapy was superior to commencing a conventional first-line DMT and escalation.
The study, published in JAMA Neurology, compared disability outcomes in Swedish and Danish MS Registry cohorts of 2,700 and 1,966 adult patients with RRMS respectively.
Danish patients were more likely to start treatment with a conventional first-line DMT, primarily teriflunomide compared to Swedish patients (42% v 2.4%).
Danish patients were also less likely than Swedish patients to initiate treatment with a highly effective DMT such as rituximab (0.1% v 17.9%) and natalizumab (4.8% v 11.1%).
The study said Sweden did not receive a full indication for teriflunomide until 2016 – later than in Denmark – and off-label prescribing of rituximab had become more common.
It said the recommendations to initiate DMT and when to escalate treatment in the case of breakthrough disease activity were similar in both countries.
“However, in clinical practice in Sweden, there has been a shift to begin highly effective DMT also in patients with less disease activity or fewer neurologic adverse effects.”
The investigators found the Swedish treatment strategy was associated with a 29% reduction in the rate of post-baseline confirmed disability worsening (CDW) relative to the Danish strategy (HR 0.71; p=0.004).