4CPS-109 Analysis of changes in disease modifying treatment in the management of patients with multiple sclerosis

Background and importanceCurrently, several disease modifying drugs are approved for multiple sclerosis (MS). IFNβ-1b, IFNβ-1a, pegIFNβ-1a, glatiramer acetate, teriflunomide and dimethylfumarate are indicated for firstline therapy. Secondline treatment includes natalizumab, fingolimod, alemtuzumab, cladribine and ocrelizumab. When disease progresses, modifications between firstline drugs or switch to a secondline drug are proposed. It is essential to know their efficacy and security profiles in order to decide which is the best option for each patient.Aim and objectivesThe main aim was to assess the reasons for changes in disease modifying drugs in MS patients in routine clinical practice.Material and methodsWe included patients with MS who changed their treatment between 23 May 2018 and 26 March 2019. The collected data were duration of initial therapy, disease modifying drugs before and after the modification and reasons for treatment modification.ResultsForty-two patients had treatment modification during the study period, 26 (62%) were women and mean age was 47 (SD 9.3) years. Twenty-four patients (57%) had received one previous treatment, 10 (24%) two previous treatments and 8 (19%) three or more previous treatments. Median duration of previous treatment was 44 months (range 3–282). Previous treatment was a firstline drug in 34 patients (81%) and modified treatment was a firstline drug in 24 (57%). The main drugs used before the modification were IFNβ-1a (21%) and teriflunomide (21%), and after the modification dimethylfumarate (38%) and natalizumab (24%). The reasons for treatment change were suboptimal response (24 patients; 57%), treatment intolerance (12 patients; 29%) and JC virus activation with progressive multifocal leucoencephalopathy risk (6 patients; 14%). Among patients with suboptimal response to treatment, 12 (50%) were treated with IFN and 8 (33%) with teriflunomide or dimethylfumarate. Most remarkable reasons for treatment intolerance were IFN related flu-like symptoms.Conclusion and relevanceSuboptimal response was the main reason for change in disease modifying treatment in MS patients in routine clinical practice. We must consider that these patients have a high relapse risk and accumulate their impairment.Most patients were treated with firstline drugs before and after the modification. Secondline drugs are more effective but, due to the higher risk of adverse events, are restricted to patients who cannot receive any firstline drug