Relapses during SPMS are a treatable target to reduce disability progression

Multiple sclerosis

By Michael Woodhead

30 Jul 2020

Dr Tomas Kalincik

Disease-modifying therapies are associated with a slower rate of disability accumulation in patients with active secondary progressive multiple sclerosis (SPMS), Australian-led research shows.

An international study led by researchers from the University of Melbourne’s Clinical Outcomes Research Unit (CORe), has shown that relapses in patients with SPMS represent a treatable target and are associated with a positive immunotherapy response.

In a cohort study of 1621 patients with secondary progressive multiple sclerosis, relapses during the secondary progressive disease stage were associated with a faster rate of disability accumulation, as measured by disability scores and risk of becoming wheelchair dependent.

The study, led by Dr Tomas Kalincik, a neurologist at the Royal Melbourne Hospital, also showed that immunotherapies were associated with reductions in disability accumulation among patients who experienced superimposed relapses during the course of secondary progressive disease.

Patients with active secondary progressive multiple sclerosis who were receiving sustained immunotherapy were less likely to become wheelchair-dependent than those who were not receiving immunotherapy, according to the study findings published in JAMA Neurology.

The results were obtained from a review of patient data prospectively collected from the MSBase international registry between 1995 and 2018. About two thirds (68%) of the patients were female, with a mean age at MS onset of 34 years.

The study found that although early active treatment during RRMS is associated with a delay in the onset of SPMS, the rate of disability progression after the onset of SPMS was not associated with the early relapsing-remitting MS course and treatment decisions.

Higher relapse rates during the secondary progressive disease stage were associated with an increased risk of becoming wheelchair dependent (hazard ratio [HR], 1.87).

Among the 41% of patients who experienced superimposed relapses during SPMS, greater receipt of disease-modifying therapies was significantly associated with a reduced rate of disability progression, the study investigators noted.

This progression translated into a marked slowing of disability progression by a mean of 1.12 EDSS steps (70%) over 10 years in patients who were actively receiving treatment and who had indications of episodic inflammation after SPMS conversion.

“These patients were also more than 70% less likely to become wheelchair-dependent if they consistently sustained treatment with medium-efficacy or high-efficacy disease modifying therapies,” the authors wrote.

However, disease-modifying therapies had little association with disability accumulation in the patients who did not experience relapses during SPMS.

They concluded that as with PPMS, relapses during SPMS represent an accessible treatment target and a marker of likely response to immunotherapy.

“Thus, when inflammation exists in patients with progressive MS, treatment may be associated with a reduction in the rate of disability accumulation. Such an interpretation is consistent with the present disease classification, in which relapses and progression represent two only partially dependent characteristics of each individual disease.”

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