Disease-Modifying Therapies for Multiple Sclerosis

Efficacy of Disease-Modifying Therapies

The National Institute for Health and Care Excellence recommends interferon beta (IFNβ) for relapsing forms of multiple sclerosis, as the ETOMS trial showed that IFNβ1a reduced brain atrophy by 30% in patients with clinically isolated syndromes compared to placebo 1, 2
The American Academy of Neurology suggests that glatiramer acetate has positive effects in patients who received it from the beginning of trials compared to those who received it later 2
The European Medicines Agency approves dimethyl fumarate for relapsing forms of multiple sclerosis, as the DEFINE trial showed that dimethyl fumarate reduced brain atrophy compared to placebo 1, 2
The National Multiple Sclerosis Society recommends fingolimod for relapsing forms of MS, as the FREEDOMS 1 and 2 trials showed fingolimod reduced brain atrophy compared to placebo 1, 2
The American College of Neurology suggests that alemtuzumab reduces brain atrophy compared to subcutaneous IFNβ1a, as shown in the CARE-MS 1 and 2 trials 1, 2
The European Committee for Treatment and Research in Multiple Sclerosis recommends ocrelizumab for relapsing MS and primary progressive MS, as the OPERA 1 and 2 trials showed ocrelizumab reduced brain atrophy compared to subcutaneous IFNβ1a 1, 2, 3
The National Institute for Health and Care Excellence suggests that cladribine reduces brain atrophy compared to placebo, as shown in the CLARITY trial 1, 2

The Centers for Disease Control and Prevention recommends that vaccines should be administered at least 4-6 weeks before starting immunosuppressive therapies like ocrelizumab or at least 4-6 months after the last treatment course 4
The Infectious Diseases Society of America suggests that for patients on β-interferons, glatiramer acetate, teriflunomide, dimethyl fumarate, natalizumab, or sphingosine-1-phosphate receptor modulators, vaccination can be administered at any time during treatment 4
The National Multiple Sclerosis Society states that brain volume loss (atrophy) is an important measure of tissue damage in MS patients and is associated with cognitive impairment, fatigue, and disability progression 5, 6

The American Academy of Neurology warns that pseudoatrophy effect can cause excessive decrease in brain volume within the first 6-12 months of treatment due to resolution of inflammation and edema, which should not be mistaken for disease progression 5, 6
The European Medicines Agency recommends that appropriate washout periods between different DMTs are essential to avoid complications from carryover effects 7