Sequencing of and escalation paradigms for MS therapies: time for a rethink?

The choice of MS DMTs in a treatment escalation paradigm may adversely effect long-term outcomes in those with active disease

Pfeuffer et al1 report on a real-world experiment that assesses the role of prior multiple sclerosis (MS) disease-modifying therapy (DMT) use in determining outcomes after switching to alemtuzumab (ALEM). The study enrolled 170 cases from two German academic MS centres and included naïve cases as well as those treated with often multiple prior DMTs. They compared outcomes at least 1 year post ALEM with a median of 44 months follow-up. Their primary outcomes were 3-month confirmed disability progression, relapse rate, risk of secondary autoimmunity and relapse phenotype.

They found that those who had received three or more prior DMTs were significantly more likely to relapse post ALEM and were more likely to experience disability progression. Which is not surprising as most switches of therapy were made because of disease…

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