When you select a DMT it is clearly not based on efficacy. Why not?
I guess it is safety.
If it were efficacy GA would not be doing so well in the sales. This study says what you all know, that GA is bottom of the pile. The label says it works by “mechanisms thought to be responsible for MS” and so we get a new mechanism with every new idea of how MS occurs. Therefore, it says to me what ever GA does, it must do it relativelybadly. If it didn’t it would be more effective in the real world.
It was reasssuring to see at ECTRIMS2019 that GA was not that great in depleting memory B cells, interefon beta was better and fingolimod was much better. Natalizumab increases the memory B cells in the blood because it traps them there. So this idea fits with the real world data
You say but MD…GA works so well in EAE.
However, that is not exactly true. It works well when used in one way and that is when you mix it with the mush that you use to make EAE. Inject it under the skin after you have done the sensitization and you see why I am not a big fan.
The effectiveness of interferon beta versus glatiramer acetate and natalizumab versus fingolimod in a Polish real-world population. Kapica-Topczewska K, Tarasiuk J, Collin F, Brola W, Chorąży M, Czarnowska A, Kwaśniewski M, Bartosik-Psujek H, Adamczyk-Sowa M, Kochanowicz J, Kułakowska A. PLoS One. 2019;14(10):e0223863.
OBJECTIVE:The aim of the study was to assess the effectiveness of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients treated in MS centres in Poland.
METHODS:Demographic and clinical data of all Polish RRMS patients receiving DMTs were prospectively collected from 2014 to 2018 in electronic files using the Therapeutic Program Monitoring System (SMPT).
RESULTS: The study included 10,764 RRMS patients treated with DMTs in first-line and 1,042 in second-line programmes. IFNβ more effectively lengthened the times to the first relapse, disability progression, and brain MRI activity than GA. After 2 and 4 years of follow-up, more patients on IFNβ showed no evidence of disease activity (NEDA-3) in comparison to GA (66.3% and 44.3% vs 55.2% and 33.2%, respectively; p<0.001). NAT more effectively reduced brain MRI activity than FTY (p = 0.001). More patients under NAT had NEDA-3 after 2 and 4 years of follow-up compared to FTY (66.2% and 42.1% vs 52.1% and 29.5%, respectively; p = 0.03). In adjusted analysis, a higher baseline Expanded Disability Status Score (EDSS) was a predictor of relapse (p<0.001) and NEDA-3 failure (p = 0.003).
CONCLUSION: IFNβ compared to GA and NAT compared to FTY more effectively reduced disease activity in a Polish population of RRMS patients