What is the treatment for Multiple Sclerosis (MS) with relapsing-remitting (RR) course?

From the Guidelines

Autologous haematopoietic stem cell transplantation (AHSCT) is recommended as a treatment option for relapsing-remitting multiple sclerosis (RRMS) that is refractory to conventional disease-modifying therapies (DMTs) due to its potential to achieve high rates of progression-free survival and no evidence of disease activity (NEDA). This recommendation is based on the most recent and highest quality evidence from the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Society for Blood and Marrow Transplantation (EBMT) 1.

Key Considerations

• AHSCT has been endorsed as a standard of care for the treatment of RRMS that is refractory to conventional DMTs by several reputable organizations, including the EBMT, the American Society for Blood and Marrow Transplantation, and the US National Multiple Sclerosis Society 1.
• High-efficacy DMTs, such as monoclonal antibodies (alemtuzumab, natalizumab, ocrelizumab, and ofatumumab), are more effective when treatment is initiated early in the disease course 1.
• AHSCT is generally more effective than DMTs, and treatment at a younger age and after a lower number of previous DMTs is associated with lower rates of long-term progression 1.
• The average age of participants in studies of AHSCT for RRMS ranged from 27 years to 44 years, reflecting appropriate age windows for this treatment option 1.

Treatment Outcomes

• Studies have shown that AHSCT can achieve high rates of progression-free survival (80-100%) and NEDA (70-80%) in patients with RRMS 1.
• Long-term outcomes in a large cohort of patients treated with AHSCT for MS demonstrated overall progression-free survival at 5 years of 46%, but progression-free survival was considerably higher in the RRMS subgroup (73%) than in the progressive MS subgroup (33%) 1.
• Transplant-related mortality was high at 2.8% in one study, but lower at 1.4% in another study, highlighting the importance of careful patient selection and management 1.

Comprehensive Management

• Beyond AHSCT and DMTs, comprehensive management of RRMS includes physical therapy, occupational therapy, psychological support, and lifestyle modifications like regular exercise, adequate rest, stress management, and a balanced diet.
• Early treatment is crucial as it can significantly reduce relapse frequency, slow disability progression, and preserve neurological function over time.

From the FDA Drug Label

1 INDICATIONS AND USAGE REBIF is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

1 INDICATIONS AND USAGE 1. 1 Multiple Sclerosis (MS) TYSABRI is indicated as monotherapy for the treatment of relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.

Multiple Sclerosis Relapsing Remitting Treatment:

• Interferon beta-1a (SQ) and Natalizumab are indicated for the treatment of relapsing-remitting multiple sclerosis 2 3.
• These medications can be used as monotherapy for the treatment of relapsing forms of multiple sclerosis, including relapsing-remitting disease, in adults.

From the Research

Multiple Sclerosis Relapsing-Remitting Treatment

• The treatment of relapsing-remitting multiple sclerosis (MS) involves the use of disease-modifying therapies (DMTs) to reduce the frequency and severity of relapses and slow disease progression 4.
• Interferon-beta-1b is a well-established DMT that has been shown to be effective in reducing relapse rates and delaying disease progression in patients with relapsing-remitting MS 5, 6, 7.
• The efficacy of interferon-beta-1b has been demonstrated in several clinical trials, including a randomized, double-blind trial that showed a significant reduction in annual relapse rate and an increase in the proportion of relapse-free patients compared to placebo 5.
• Interferon-beta-1b is generally well-tolerated, with common adverse events including injection site reactions, flu-like symptoms, and asthenia 5, 6, 7.
• Patient education and mitigation strategies, such as the use of autoinjectors and protocol changes, can help improve tolerability and adherence to interferon-beta-1b therapy 7.

Treatment Options and Considerations

• The choice of initial therapy for relapsing-remitting MS should take into account factors such as efficacy, safety, and tolerability, as well as patient characteristics, personal preferences, and comorbid illnesses 4.
• Interferon-beta-1b is a valuable first-line therapy for patients with relapsing-remitting MS, and its long-term safety profile makes it an important option for treatment 8, 7.
• Other DMTs, such as glatiramer acetate and peginterferon beta-1a, may also be considered as treatment options for relapsing-remitting MS 8, 7.
• The timing of therapy initiation is also an important consideration, with early initiation of DMTs shown to have a beneficial effect on relapse prevention and disease progression 4.