Therapies that reduce immune-system B cells were associated with substantially fewer relapses in the early stages of multiple sclerosis in a study of 509 newly diagnosed patients. The analysis also found fewer MRI changes linked with the disease among people who began B-cell-depleting treatment, although disability scores did not clearly differ between treatment groups after two years.
The findings, published in Neurology, add real-world comparative evidence to a treatment decision that has become more complicated as the number of MS medicines has grown. They do not establish that one initial therapy is best for every patient, but they point to meaningful differences in the disease activity seen soon after diagnosis.
Four treatment approaches, plus no early treatment
Researchers followed people newly diagnosed with relapsing or progressive multiple sclerosis and grouped them according to the first treatment they received. The options included injectable therapies such as interferon-beta and glatiramer acetate; oral medicines including dimethyl fumarate and teriflunomide; higher-efficacy therapies such as fingolimod, cladribine, natalizumab and alemtuzumab; and B-cell-depleting therapies, rituximab and ocrelizumab.
Ninety participants who did not receive early treatment were also included in the analysis. The average age across the study population was 33. That focus on people near the beginning of their disease course is important: treatment choices made early can affect the frequency of clinical attacks and the MRI evidence clinicians use to track inflammatory activity.
MS is a disease in which the immune system damages the central nervous system. Its course can vary considerably from person to person, and clinicians consider a range of factors when selecting treatment, including symptoms, disease activity, risks, convenience and a patient’s circumstances. The study’s authors emphasized that the groups already differed in important ways, suggesting doctors were making treatment choices partly on individual patient characteristics.
Lower relapse rates with B-cell depletion
The clearest result concerned relapses. Patients receiving intravenous drugs that reduce B-cell levels had a 62% lower relapse rate than those receiving commonly prescribed oral medicines for early MS, according to the study summary. The lowest relapse rate was seen in the B-cell-depleting group.
Other strong treatments were also linked with fewer relapses and fewer MRI changes than less intensive approaches. That pattern matters because relapses can bring new or worsening neurological symptoms and because MRI scans can show signs of disease activity even when a person is not experiencing an obvious clinical attack.
The analysis also found that patients were less likely to develop brain scarring associated with MS when B-cell-depleting therapy was started shortly after diagnosis. MRI changes are not interchangeable with a person’s day-to-day function, but they are a key measure clinicians use alongside symptoms and examinations when assessing how active the disease is.
Disability result adds an important limit
The results were not a simple declaration of a winner. Across the two years after diagnosis, disability progressed by about the same amount among the treatment groups. In other words, the early advantages in relapse rate and MRI findings did not translate into a clear separation in disability scores within the period studied.
That distinction is central to interpreting the work. A lower relapse rate is clinically meaningful, and fewer MRI changes may indicate less inflammatory activity. But the study does not show that B-cell-depleting therapy produced a measurable disability advantage over every other initial option during two years of follow-up.
Senior researcher Fredrik Piehl, a neurology professor at Karolinska Institutet in Stockholm, said the expanding array of treatments has not made the first-choice decision easy. He noted that treatment groups differed in characteristics before the outcomes were assessed, but said B-cell-depleting therapies and other strong treatments were associated with fewer relapses and MRI changes.
Why the comparison is useful
There has been a rapid expansion in MS medicines over the past two decades, yet head-to-head comparisons among initial treatments remain limited. Studies based on routine clinical care cannot fully remove the effect of treatment selection: a physician may choose a stronger medicine for a person whose disease appears more active, or avoid a particular option because of safety, access or personal considerations.
The researchers acknowledged this challenge directly. Because the treatment groups differed in important patient characteristics, the associations reported in the study should not be read as proof that treatment assignment alone caused every observed difference. Still, the analysis offers evidence from a substantial group of newly diagnosed patients facing the same broad decision clinicians confront in practice: whether to begin with a more moderate option or use a high-efficacy therapy earlier.
What patients and clinicians can take from it
- B-cell-depleting therapies were associated with the lowest relapse rates in this early-MS analysis.
- Those therapies were also associated with fewer MRI changes linked to MS.
- Disability scores did not show clear differences between initial treatment groups over two years.
- Individual treatment decisions still need to account for patient characteristics and the trade-offs of available options.
The study therefore strengthens the case for discussing high-efficacy treatment early after diagnosis, particularly when the goal is to reduce relapses and MRI activity. It does not replace individualized decision-making, nor does it settle longer-term questions about disability outcomes. Longer follow-up and further comparative research will be needed to determine whether early differences in inflammatory disease activity lead to larger differences in function over time.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
