Earlier use of targeted therapies may delay MS disease progression over 5 years

Key takeaways:

• Patients who registered more persistent paramagnetic rim lesions had faster MS progression.
• Preventing new lesions would result in a 7.5% reduction in progression of independent relapse activity over 5 years.

ORLANDO, Fla. — Patients with MS who developed paramagnetic rim lesions declined more rapidly, but implementing disease-modifying therapies earlier could reduce the burden of disease progression, data show.

The findings, which were presented at the American Neurological Association annual meeting, suggest that physicians should assess levels of paramagnetic rim lesions (PRLs) as part of the standard workup for MS, Jack Reeves, PhD, lead study author and doctoral candidate at Jacobs School of Medicine and Biomedical Engineering at the State University of New York at Buffalo, said in a press release.

Although the effects of PRL in MS are known to lead to faster disease progression, it was unknown if prevention or elimination may lead to better clinical outcomes, Reeves and colleagues wrote. They sought to quantify the impact of PRL appearance, disappearance and persistence over 5 years and whether the timing of disease-modifying therapy (DMT) affects disease progression.

Their study included 155 individuals with MS who had undergone a 3T MRI at baseline and at a 5-year follow up. Patients had logged sufficient clinical data to determine 5-year confirmed disease progression (CDP), as well as progression of independent relapse activity (PIRA).

PRLs were classified into three groups: persisting (detected at baseline and follow up), disappearing (detected at baseline but not follow up) and newly appearing (emergent by follow up).

The researchers controlled the analyses for sex and baseline characteristics, such as age, disease duration and MS disease course, as well as follow-up time and number of clinical visits. They also controlled for baseline PRL levels when assessing PRL appearance and disappearance.

The researchers additionally estimated the effects of reducing persisting PRLs to zero or preventing new PRL appearance on the prevalence of CDP and PIRA.

According to the results, preventing new PRLs would result in a 7.5% reduction in PIRA-related decline over 5 years, while data further showed that those who registered a higher number of persistent PRLs had faster MS progression.

Reeves and colleagues additionally estimated that treatments directed specifically at persistent PRLs may reduce 5-year PIRA prevalence by 29% and 5-year CDP prevalence by 19%. Meanwhile, reducing persisting PRLs to zero would result in a 45.6% relative reduction in 5-year PIRA prevalence and a 27.1% relative reduction in 5-year CDP prevalence.

Also, complete prevention of new PRLs would result in a 14% relative reduction in 5-year PIRA prevalence, the researchers wrote.

“Starting patients on high-efficacy DMTs may lead to better clinical outcomes by preventing PRLs from occurring and should be the gold standard for patients with higher disease activity,” Reeves said in the release.

Reference:

MS patients with chronic brain lesions decline faster. https://www.newswise.com/articles/ms-patients-with-chronic-brain-lesions-decline-faster. Published Sept. 16, 2024. Accessed Sept. 16, 2024.