First-ever treatment in multiple sclerosis

• Published in: Revue neurologique 2021-01, Vol.177 (1-2), p.93-99
• Main Authors: Pantazou, V., Pot, C., Du Pasquier, R., Le Goff, G., Théaudin, M.
• Format: Article
• Language: English
• Subjects: Dimethyl fumarate; Disease modifying treatment; Fingolimod; Multiple sclerosis; Real-world study
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2020.05.014

•Both fingolimod and dimethyl fumarate reduce significantly the risk of disease progression in early-treated treatment-naive patients.•There seems to be a prescription bias towards fingolimod in more active patients.•Highly active patients at baseline are at higher risk of disease progression. The current treated MS population is very different from that of patients in randomized clinical trials. To study the long-term efficacy and tolerance of fingolimod (FTY) and dimethyl fumarate (DMF), both available as first-line treatment in early-treated treatment-naïve MS patients. Retrospective analysis of 75 patients from our prospective MS registry fulfilling the inclusion criteria: FTY or DMF as first-line treatment, treatment initiation within 36months of disease onset and treatment duration>12months. Demographics and MRI characteristics at baseline were similar in both groups (FTY 55 patients, DMF 20), but patients on FTY had higher pretreatment clinical activity (P=0.008). Twenty-two percent of patients in the FTY group and 15% in the DMF group had highly active disease. At last follow-up (mean: 44.2, SD: 17.3months), the majority of the patients were still on treatment while 54.5% of FTY and 65% of DMF patients reached NEDA 3 status (P=0.444). Both treatments significantly decreased relapses and occurrence of new T1 Gd-enhancing lesions (P