Switching treatment may help MS patients: study

Monash University researchers used the world’s largest multiple sclerosis (MS) registry, MSBase, to provide evidence that will help people with MS take the best medicine for them.

People with MS often need to switch medications to fully control their disease. These switching decisions are complex because until now, there was no solid evidence to choose one new drug over another.

Led by researchers from the MS Clinical Neuroimmunology group in Monash University’s Department of Neuroscience, the study created this much-needed evidence.

It determined disease outcomes for three common medications that people turn to after stopping fingolimod, a popular MS drug, due to disease onset or side effects. The results will allow people with MS and their healthcare teams to make evidence-based decisions about medications.

Multiple sclerosis is a complex condition of the central nervous system that interferes with nerve impulses in the brain, spinal cord and optic nerves. It affects more than 25,600 people in Australia.

Although treatments have improved dramatically, researchers have yet to uncover its cause or discover a cure. Most patients will require lifelong treatment to minimize disease progression.

Published in the Journal of Neurology, Neurosurgery and Psychiatry, the study found that the number of relapses in patients with the most common form of MS (relapsing-remitting) was well controlled and the disability stabilized or subsided. improved when those stopping fingolimod switched to ocrelizumab or natalizumab.

Relapsing-remitting MS is the most common form in which new symptoms (relapses) appear over at least 24 hours and worsen. They are then followed by a period of remission (remitting) when the symptoms disappear partially or completely. Fingolimod is approved as a first-line treatment for MS in Australia, the United States, Canada and other countries. But after a few years of treatment, many patients stop taking it due to unwanted side effects, new relapses or disease progression.

These patients then often experience severe relapses that lead to further disability, affecting their quality of daily life.

Lead author Professor Helmut Butzkueven, head of Alfred Health’s department of neurology and chief executive of the MSBase foundation, headquartered at Monash University, said current practice after fingolimod n was not guided by evidence, a gap that this article has filled.

Professor Butzkueven said the results were great news for patients who need to stop taking fingolimod. “Specialists don’t know what is the optimal treatment to provide MS patients when they need to stop fingolimod,” he said. “Now we can use the insights from our study to inform their practice and help patients get the most out of their disease.”

Professor Butzkueven said the results were particularly interesting because previous studies had not directly looked at the effectiveness of these three drugs after fingolimod was stopped, only the effectiveness of each drug compared to placebo.

“Our study provides a more complete picture which is valuable for specialists and people with MS to manage their condition,” he said. “It’s great research because I was able to apply it in our busy MS clinic the day we got the results.

First author and biostatistician Dr. Chao Zhu applied a sophisticated statistical approach to the analysis that helped the team reach their conclusions.

Ocrelizumab performed best in reducing annualized relapse rate, followed by natalizumab and cladribine. Natalizumab was found to have the most improvement in disability and patients persisted the longest on ocrelizumab.

The next step in the research is to assess the safety of the three drugs compared to fingolimod. This is key to understanding the overall clinical benefit and will add more evidence for specialists to guide patient treatment.

The MSBase Foundation, housed in the Department of Neuroscience at Monash University in Melbourne, enables more than 900 clinicians worldwide to monitor outcomes for people with MS. His data has been used in more than 90 publications improving care for people with MS over the past 9 years.

Source: Comparison of switching to ocrelizumab, cladribine or natalizumab after discontinuation of fingolimod treatment in multiple sclerosis by Zhu C, Zhou Z, Roos I,… Butzkueven H, on behalf of the study group MSBase. Comparison of switching to ocrelizumab, cladribine or natalizumab after discontinuation of fingolimod treatment in multiple sclerosis. JNNP. 2022

DOI: 10.1136/jnnp-2022-330104

/Public release. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the authors.