DMTs, especially oral agents, drive 'clinically meaningful' improvements in RRMS

Treatment for relapsing-remitting MS improved in a “clinically meaningful” way between 2010 and 2018, in part due to the availability of new, primarily oral disease-modifying therapies, according to findings published in BMJ Open Access.

“The field of MS treatment has seen dynamic developments over the last three decades,” Stefan Braune, MD, of NeuroTransData GmbH, Neuburg an der Donau, Germany, and colleagues wrote. “However, little is known about the impact of these developments on real-world treatment pattern and effectiveness on disease activity in RRMS. This analysis investigates treatment pattern and effectiveness over time by comparing three time periods between 2010 and 2018 (defined by availability of new DMTs entering the German market) of real-world data (RWD) from the physician’s network NeuroTransData (NTD) in Germany.”

In a descriptive, real-world data study, Braune and colleagues analyzed data from 17,553 patients with RRMS (73.6% women; mean age at RRMS diagnosis, 34 years). The researchers pseudonymized and pooled participant data from clinical visits in 67 German neurology outpatient offices included in the NeuroTransData (NTD) MS registry between Jan. 1, 2010, and June 30, 2019.

Researchers assessed adherence to, and clinical effectiveness of, different DMTs in three time periods (2010-2012; 2013-2015; 2016-2018). Over the course of the study, patients took injectable DMTs, oral DMTs and DMT infusions, which the researchers used to classify patients.

Study results demonstrated that an increasing percentage of patients with RRMS were treated with DMTs between 2010 and 2018 (2010–2012, 70.7%; 2013–2015, 78.1%; 2016–2018, 80.1%), and the availability of oral DMTs during the 2013-2015 period caused many patients to switch to oral treatment. Braune and colleagues reported that DMTs became “increasingly preferred” as the first DMT as they became available during the time periods examined in the study. Between 2010 and 2012, 74% of patients received injectable agents, 19% of patients received oral agents and 7% of patients received infusions. This shifted to 44% of patients on injectables, 52% on oral agents and 4% on infusions in 2013-2015 and to 40% on injectables, 55% on oral agents and 5% on infusions in 2016-2018.

Overall, researchers saw a consistent decrease of annualized relapse rates, less frequent Expanded Disability Status Scale progression and increasing periods without relapse, EDSS worsening and with stability of no-evidence-of-disease-activity 2 and 3 criteria and lower conversion rates to secondary progressive MS on oral and on injectable DMTs.

Limitation of this study included the enrollment of only German outpatients with RRMS, the use of German DMT labels and varying follow-up times.

“These results indicate that there is an overall beneficial effect for the whole patient with MS population as a result of the greater selection of available DMTs, a benefit beyond the head-to-head comparative efficacy, resulting from an increased probability and readiness to individualize MS therapy,” Braune and colleagues wrote. “Promising techniques emerge based on biomarker like neurofilament light chain or B-cell activity response or RWD-based statistical predictive algorithms. As treatment decisions are driven currently by European label definitions, national cost control regulations and perceptions of physicians and patients, personalized data-based decision support is required to further improve individual care.”