High-Efficacy Therapies (HETs) First Versus an Escalation Approach in Multiple Sclerosis: A Targeted Literature Review

Speaker(s)

Hussain S1, Bhutani MK1, Tiwari S1, Rajora P1, Madiraju S1, Grennan O2, Adlard N3, Brennan R2
1Novartis Healthcare Private Limited, Hyderabad, Telangana, India, 2Novartis Ireland Limited, Dublin, Ireland, 3Novartis Pharma AG, Basel, BS, Switzerland

Presentation Documents

OBJECTIVES: There are over 20 disease-modifying therapies (DMTs) available for the treatment of multiple sclerosis (MS). Two different treatment paradigms viz., an escalation approach (i.e., switching from a low- or moderate-efficacy DMT to high-efficacy therapies [HETs]) or initiating HET first are most often used in MS. The objective of this targeted literature review (TLR) was to identify and summarize evidence on the benefits of HETs first vs. escalation approach in patients with MS.

METHODS: A targeted literature search of MEDLINE, Embase, and Cochrane database via OVIDTM platform was conducted in January 2024. Studies reporting HETs first or escalation approach during 2016 to 2023 in patients with MS were included. The database search was supplemented with grey literature searches.

RESULTS: The TLR identified a total of 66 studies on the HETs first and 53 studies on an escalation approach. Majority of the studies (94%; 62/66) demonstrated benefits of HETs first, while 55% (29/53) studies demonstrated benefits of the escalation approach. Higher percentages of studies supported the use of HET first vs. escalation approach in terms of lower relapse rate (50% vs. 36%), delay in disability progression (45% vs. 28%), higher probability of achieving NEDA (27% vs. 13%), reduction in active MRI lesions (15% vs. 6%), greater improvements in cognitive functioning (with HETs first only: 5%), lowering disease transition (with HETs first only: 2%), and decrease in the rate of brain volume loss (with escalation approach only: 2%). Twenty studies reported head-to-head comparison, of which 15 (75%) studies reported benefits of HETs first, 3 (15%) reported benefits of escalation approach, and the remaining 2 studies (10%) reported benefits of both the approaches.

CONCLUSIONS: Overall, the current TLR suggests that HETs first offer better therapeutic benefits to patients with MS than those receiving an escalation approach.

Code

CO78

Topic

Clinical Outcomes, Study Approaches

Topic Subcategory

Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy, Literature Review & Synthesis

Disease

Drugs, Neurological Disorders