I’ve been harping on about this strategy for the better half of the past two years, and lo and behold someone has actually done it, and it actually works. The drugs utilized in this study are in fact irrelevant, the importance is the strategy itself.
What strategy you ask?
I’m glad you asked. The one where you go in with all guns blazing and then follow it up with diplomacy. In the world of MS immunotherapy, this a highly active induction treatment taken at intervals to achieve immunodepletion, followed by regular maintenance treatment that happens to be less efficacious.
OBJECTIVE: To examine whether rituximab induction followed by glatiramer acetate (GA) monotherapy is more effective than GA alone for the treatment of relapsing multiple sclerosis with active disease.
METHODS: This was a
RESULTS: Twenty-eight and 27 participants received rituximab and placebo induction, respectively, with one participant in each arm withdrawing before 6-month MRI. There were no significant differences in baseline characteristics. At end of
CONCLUSIONS: Induction therapy with rituximab followed by GA may provide superior efficacy in the short term than GA alone in relapsing multiple sclerosis, but this benefit appears to wane within the study period. Larger studies are needed to assess
CLINICALTRIALSGOV IDENTIFIER: NCT01569451.
Roughly 44% had no evidence of disease activity (NEDA) on rituximab induction treatment followed by glatiramer acetate (Copaxone) maintenance treatment, whilst only 19% on placebo (or dummy) induction followed by glatiramer actetate achieved NEDA. In another words the induction-maintenance strategy is better than the old maintenance strategy alone.
Great you say, I would agree with you on that one. NEDA, which includes not only no relapses, but no MRI activity or disease progression based on worsening disability is a hard target to achieve. But, the authors are somewhat missing the point. The main reason for utilizing this strategy is not to improve the effectiveness of a lesser treatment (in this case glatiramer acetate) by going first with a more highly active treatment, but in fact, de-risking MS treatments all together. Since, all aficionados in this field have been discussing is how we seem to have more choice than ever before for treating MS, but they’re all scary possibilities; because of the PML risk. This then is exactly the type of strategy to use in treating RRMS when you want to avoid PML and other nasty infections, cancers etc.
Am I miffed that someone has already done it before us? No, not at all. This is the strategy for the future, and it’s about time we moved it along.
What about if you break-though in disease activity in the maintenance phase, you ask? Well, simply go all the way back for another induction phase. And hey presto, RRMS is sorted!