Oral disease modifying therapies - A game changer for treatment decision in untreated patients with RRMS and CIS? - A swiss single center cross-sectional study

Sebastian Finkener; Lutz Achtnichts; Michaela Cervenakova; Krassen Nedeltchev; Oliver Findling

doi:10.1016/j.msard.2022.104396

Oral disease modifying therapies - A game changer for treatment decision in untreated patients with RRMS and CIS? - A swiss single center cross-sectional study

Mult Scler Relat Disord. 2022 Dec:68:104396. doi: 10.1016/j.msard.2022.104396. Epub 2022 Nov 2.

Authors

Sebastian Finkener¹, Lutz Achtnichts², Michaela Cervenakova², Krassen Nedeltchev³, Oliver Findling⁴

Affiliations

¹ Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland. Electronic address: sebastian.finkener@ksa.ch.
² Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland.
³ Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland; University of Bern, Bern, Switzerland.
⁴ Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland; MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel(RC2NB),Head, Spine and Neuromedicine, Clinical Research and Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland.

PMID: 36544325
DOI: 10.1016/j.msard.2022.104396

Abstract

Introduction: Several disease-modifying therapies (DMTs) show efficacy in relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS). However, there is still a relevant proportion of patients who remain untreated. We provide real-world data on untreated and treated patients and we report whether and how the introduction of oral DMTs changed the treatment decision. Furthermore, we discuss possible reasons for not receiving DMTs.

Methods: We conducted a retrospective cross-sectional study and analysed demographic and clinical data of patients with RRMS and CIS at our MS center. Comparison was made between untreated and treated patients in 2010 (before the introduction of oral DMTs) and in 2014 (after the introduction of oral DMTs). Furthermore, we analysed reasons for the decision against DMTs in patients who never received DMTs and patients who discontinued DMTs.

Results: We analysed datasets of 344 MS patients in 2010 and 253 in 2014. There were more untreated patients in CIS than in RRMS. In RRMS, the proportion of untreated patients decreased significantly between 2010 and 2014 from 23.6% to 11.1%, while the use of oral medications increased significantly from <1% to more than 50% in 2014. In CIS, there was no significant change in untreated patients between 2010 and 2014 (61.1% in 2010 to 52.6% in 2014). Untreated patients with RRMS were significantly older and had lower ARR than treated patients. Patients who never received DMT had lower EDSS compared to patients that had been treated before. The main reasons for the decision against DMT were "belief in a benign course" and "fear of adverse effects". Treatment discontinuation was caused mainly by the adverse effects.

Discussion: In our data a relevant proportion of patients with RRMS and CIS did not receive any DMT. We hypothesize that in patients with RRMS the introduction of oral DMTs translated to a higher rate of treatment, whereas in CIS there no change was observed. This could be due to limited therapeutic options in CIS. There is more information needed regarding the treatment recommendation for older patients and patients with mild course of the disease.

Keywords: Disease-modifying therapies; Multiple sclerosis; Relapsing-remitting; Switzerland; Untreated.

MeSH terms

Cross-Sectional Studies
Humans
Multiple Sclerosis*
Multiple Sclerosis, Relapsing-Remitting* / drug therapy
Retrospective Studies
Switzerland