Research published online in Neurology found that high-efficacy therapy is more effective than less potent drugs in reducing the number of relapses in secondary progressive multiple sclerosis (MS). But the study found no difference in the speed of disease progression between high- and low-efficacy therapy.

Patients with MS are typically diagnosed with relapsing-remitting MS and alternate between relapses and remission periods. As patients transition to secondary progressive MS (SPMS), the disease steadily worsens, and relapses may not occur.

Study author Tomas Kalincik, MD, PhD, from the University of Melbourne in Australia, said in the press release that “multiple sclerosis is a complicated disease to treat and must be closely monitored as it is managed with various medications, some of which can have serious side effects.”

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“High-efficacy medications are prescribed in early multiple sclerosis to more aggressively treat the disease and have been found to more effectively prevent flare-ups and modify progression, but less is known about how effective these therapies may be later when relapsing-remitting MS transitions to secondary progressive MS,” Dr. Kalincik explained.

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In the study, 1000 participants with active and inactive SPMS were followed over 10 years to compare the clinical efficacy of both high- and low-efficacy therapies. Participants were selected from 2 large observational cohorts, MSBase and OFSEP, and divided into 2 groups, 1 with people treated with a high-efficacy (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) therapy, and a second 1 including people treated with a low-efficacy (interferon beta-1a, interferon beta-1b, glatiramer acetate, teriflunomide) therapy.

The duration of the therapeutic lag for each participant was determined using demographic and individual clinical characteristics. Researchers used propensity scores to match patients treated with high-efficacy and less potent drugs.

According to the published study, patients with active SPMS or those suffering relapses within the 2 years before starting therapy who were treated with high-efficacy drugs experienced a 30% decrease in relapses. An average of 0.17 relapses in each year was observed for study participants included in the high-efficacy group. Participants in the low-efficacy group experienced an average of 0.27 relapses per year.

The effect of the individual drugs within each group was not evaluated. Dr. Kalincik recommends that further studies are performed to address this limitation.

“Our study finding that high-efficacy therapies are superior to low-efficacy therapies only in reducing relapses in people with active secondary progressive MS provides valuable guidance for neurologists when choosing the most effective therapies for people with this form of MS.”


Are multiple sclerosis drugs used early on in the disease also effective later? News release. American Academy of Neurology; June 30, 2021
Roos I, Leray E, Casey R, et al. Effects of high and low efficacy therapy in secondary progressive multiple sclerosis. Neurology. Published online June 30, 2021. doi:10.1212/WNL.0000000000012354.