Introducing research papers published in high-impact medical journals by members of the Multiple Sclerosis group at the Melbourne Brain Centre.
PREDICTORS OF DISABILITY WORSENING IN CLINICALLY ISOLATED SYNDROME
Dr Vilija Jokubaitis
In many clinical trials that aim to test the effectiveness of new multiple sclerosis (MS) therapies, the measurement used is the presence or absence of a neurological ‘worsening event’. This is because reducing neurological disability is the main goal of early treatment in MS. However, due to the time constraints of many of these trials, the worsening event is confirmed at relatively short intervals after they occur (either 3 or 6 months time points). It is known that some disability worsening events confirmed at 3 months can later disappear.
To independently assess the ability of disease-modifying therapies (DMTs) to reduce worsening events, Jokubaitis et al utilised MSBasis, a seen-from-onset group contained within the MSBase Registry (www.msbase.org). MSBasis contains a large number of people who experienced a clinical isolated syndrome (CIS) and were seen by a neurologist within 12 months. Using this resource, 1,989 people were able to be included in the study. Of these, 391 people had a worsening event confirmed at 3 months and 307 of these events were maintained for 12 months. It was shown that the number of worsening events was greatly reduced in people taking DMTs in CIS and early MS if they took therapy for more than 50% of the time since diagnosis. It was also determined that age of onset and dysfunction in certain parts of the central nervous system were risk factors for sustained worsening disability.
Full article published in the Annals of Clinical and Translational Neurology, February 2015.
SWITCH TO NATALIZUMAB VERSUS FINGOLIMOD IN ACTIVE RELAPSING-REMITTING MULTIPLE SCLEROSIS
Dr Tomas Kalincik
The first lines of treatment for many people with multiple sclerosis (MS) are the injectable therapies, interferon beta or glatiramer acetate. These can be successful in reducing relapses and limiting disease progression in many patients. However, some people do not respond to these treatments and are then transferred to a ‘stronger’ therapy, mostly commonly natalizumab (Tysabri) or fingolimod (Gilenya). It is currently unknown whether there is a difference in terms of effectiveness between switching to either Tysabri or Gilenya.
To overcome this, Kalincik et al used the MSBase registry to analyse this question. Of 792 people included in the study, 578 were matched (407 on Tysabri and 171 on Gilenya). The results showed that while switching to either treatment reduced relapse rates markedly, Tysabri was more effective at this than Gilenya. Patients who switched to Tysabri were also more likely to partially recover from the disability which they had developed previously. No difference was observed in accumulation of new disability when switching to either treatment. This provides evidence that people with MS that are not responding to injectable therapies may receive more benefit from switching to Tysabri than Gilenya.
Full article published in the Annals of Neurology, March 2015.