A Review of the Impact of Platform Therapies (DMTs) on Associated Clinical Symptoms of Multiple Sclerosis

Santosh B Shirol,1 Kannan Subramaniam,2 Tjalf Ziemssen3 1Global Medical Affairs, Viatris, Bangalore, India; 2Global Medical Affairs, Viatris, Auckland, New Zealand; 3Center of Clinical Neuroscience, Neurological Clinic, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, GermanyCorrespondence: Santosh B Shirol, Global Medical Affairs, Viatris, 7-11th Floor, Kadubeesenahalli, Varthur ORR, Marathahalli, Bangalore, 560103, India, Tel +91 97311 66776, Email [email protected]: Persons with multiple sclerosis (pwMS) experience varied symptoms, often influencing clinical decisions. Symptoms including cognitive deficits, pain, fatigue, and depression profoundly impact quality of life (QoL). Disease-modifying therapies (DMTs) primarily focus on reducing relapses and delaying progression; however, their ability to alleviate symptoms is less known. This narrative review consolidates the current evidence of the role of platform DMTs (Glatiramer Acetate (GA), Interferon (IFN), Dimethyl Fumarate (DMF), Teriflunomide (TER)) on the associated symptoms of MS and their efficacy in prevention of relapse, and disease progression. A literature search was conducted using the PubMed database for studies assessing the impact of GA and other platform DMTs on associated symptoms and effectiveness in pwMS. Studies using specific validated scales to assess each of the symptoms in pwMS treated with platform therapies were considered. A total of 132 publications were identified, and of which 13 were found appropriate for inclusion in the review. Effectiveness outcomes included annual relapse/exacerbation rates and lesion size. The impact of platform DMTs was evaluated in 13 studies in patients with MS having associated symptoms such as cognitive deficits (n=4), pain and spasticity (n=3), and fatigue, depression and overall QoL (n=6). Additionally, eight studies assessed the overall effectiveness of GA in the treatment and management of pwMS. Although a limited number of studies compared the impact of platform therapies on MS-related symptoms, treatment with GA demonstrated statistically significant improvements in cognition, pain, spasticity and fatigue, which was also clinically meaningful on minimum detectable change parameters. This review offers insights and proposes a hypothesis for conducting a large-scale study to explore the impact of platform therapies on MS symptoms that affect quality of life. It may also aid clinicians in making evidence-based therapeutic decisions for the effective management of PwMS.Keywords: disease-modifying therapies, glatiramer acetate, interferons, persons with multiple sclerosis, quality of life