Progression independent of relapse and MRI activity and treatment strategies in multiple sclerosis

The impact of high-efficacy therapies (HET) on progression independent of relapse and MRI activity (PIRMA) remains poorly defined. In this context, using the French MS registry, we aimed to assess the real-life effectiveness of HET compared with moderate efficacy therapies (MET) on PIRMA in relapsing-onset MS (RMS) patients. Data were collected from RMS patients of the French MS Registry, between January, 2010 and June, 2023, with a mean follow-up of 3.7 years. RMS patients were included in the analysis if they were treated first with HET (2666 included) or MET (7833 included), and had EDSS and MRI follow-up every two years. Each outcome was studied using a propensity score framework. The primary outcome was time-to-first PIRMA. Secondary outcomes were PIRMA incidence, time-to-first confirmed disability progression (CDP), relapse-associated worsening (RAW), MRI-associated worsening (MAW) and identification of risk factors associated with PIRMA. A total of 10499 patients fulfilled the inclusion criteria. The mean (SD) age at treatment initiation was 36.4 (10.3) years, with a mean (SD) disease duration of 3.1 (5.1) years. The restricted mean survival (SD) time to first PIRMA was slightly significantly shorter in the HET group compared to the MET group (8.7 yrs (0.08) vs. 8.9 yrs (0.05) p=0.017). However, when looking at time-to-first CDP, it tend to be longer in the HET group compared to the MET group (7.6 (0.10) vs. 7.3 years (0.06); p=0.071), and it was probably linked to the shorter time-to-first RAW and MAW in the MET group (9.2 (0.06) vs 8.7 years (0.05); p<0.001 for RAW and 9.0 (0.05) vs 8.5 (0.07); p<0.001 for MAW). Baseline risk factors associated with increased PIRMA incidence in the whole population were: high EDSS, higher age at baseline and the presence of spinal cord lesions. Even if HET have a better control on disability accumulation related to disease activity than MET, our real-life study suggests that PIRMA-related mechanisms are not differentially affected by HET versus MET.

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Publication Details

Journal
Brain
Published
2026-02-11
DOI
https://doi.org/10.1093/brain/awag060
Citations
1
Primary Topic
Multiple Sclerosis Research Studies
Type
article
Field-Weighted Citation Impact
36.00
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article

Progression independent of relapse and MRI activity and treatment strategies in multiple sclerosis

C. Pottier, Cindy Romain, Dr Jonathan Ciron, Camille Dahan et al.
1 citations
Brain
Multiple Sclerosis Research Studies
36.00
article

Progression independent of relapse and MRI activity and treatment strategies in multiple sclerosis

C. Pottier, Cindy Romain, Dr Jonathan Ciron, Camille Dahan, Fabien Rollot, E. Thouvenot, D. Laplaud, E. Le Page, Dr Olivier Casez, Amélie Dos Santos, Abir E. Abdel Wahab, Karolina Hankiewicz, C. Papeix, Eric Manchon, A. Kerbrat, J. De Sèze, E. Maillart, MD Gilles Edan, Arnaud Kwiatkowski, Laurent Magy, Mariana Sarov Riviere, T J David, S. Moulin, Aurelie Ruet, Maya Tchikviladze, Eric Berger, Jean Pelletier, Pierre Labauge, Thibault Moreau, Jean-Philippe Camdessanché, Laure Michel, Pierre Clavelou, Sandra Vukusic, Bertrand Bourre, Inès Doghri, Clarisse Scherer Gagou, Christine Lebrun-Frenay, Olivier Heinzlef, Pierre Durozard, Gilles Defer
article en
1 citations

Abstract

The impact of high-efficacy therapies (HET) on progression independent of relapse and MRI activity (PIRMA) remains poorly defined. In this context, using the French MS registry, we aimed to assess the real-life effectiveness of HET compared with moderate efficacy therapies (MET) on PIRMA in relapsing-onset MS (RMS) patients. Data were collected from RMS patients of the French MS Registry, between January, 2010 and June, 2023, with a mean follow-up of 3.7 years. RMS patients were included in the analysis if they were treated first with HET (2666 included) or MET (7833 included), and had EDSS and MRI follow-up every two years. Each outcome was studied using a propensity score framework. The primary outcome was time-to-first PIRMA. Secondary outcomes were PIRMA incidence, time-to-first confirmed disability progression (CDP), relapse-associated worsening (RAW), MRI-associated worsening (MAW) and identification of risk factors associated with PIRMA. A total of 10499 patients fulfilled the inclusion criteria. The mean (SD) age at treatment initiation was 36.4 (10.3) years, with a mean (SD) disease duration of 3.1 (5.1) years. The restricted mean survival (SD) time to first PIRMA was slightly significantly shorter in the HET group compared to the MET group (8.7 yrs (0.08) vs. 8.9 yrs (0.05) p=0.017). However, when looking at time-to-first CDP, it tend to be longer in the HET group compared to the MET group (7.6 (0.10) vs. 7.3 years (0.06); p=0.071), and it was probably linked to the shorter time-to-first RAW and MAW in the MET group (9.2 (0.06) vs 8.7 years (0.05); p<0.001 for RAW and 9.0 (0.05) vs 8.5 (0.07); p<0.001 for MAW). Baseline risk factors associated with increased PIRMA incidence in the whole population were: high EDSS, higher age at baseline and the presence of spinal cord lesions. Even if HET have a better control on disability accumulation related to disease activity than MET, our real-life study suggests that PIRMA-related mechanisms are not differentially affected by HET versus MET.

Brain
Université Claude Bernard Lyon 1 (FR), Centre National de la Recherche Scientifique (FR), Université Toulouse III - Paul Sabatier (FR), Université de Bordeaux (FR), Inserm (FR), Université Fédérale de Toulouse Midi-Pyrénées (FR), Lyon College (US), Université de Montpellier (FR), Université de Lille (FR), Multiple Sclerosis Foundation (US), Centre Hospitalier Universitaire de Grenoble (FR), Centre Hospitalier Universitaire de Nice (FR), Centre Hospitalier Universitaire de Toulouse (FR), Université Rennes 2 (FR), Université de Poitiers (FR), Sorbonne Université (FR), Centre Hospitalier Universitaire de Besançon (FR), Centre Hospitalier Universitaire de Montpellier (FR), Centre de Recherche en Neurosciences de Lyon (FR), Centre Hospitalier Universitaire de Tours (FR), Hôpital Bretonneau (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Centre Hospitalier De Pau (FR), Observatoire Français de la Sclérose en Plaques (FR), Centre Hospitalier Universitaire de Reims (FR), Bordeaux Population Health (FR), Centre Hospitalier Intercommunal de Poissy (FR), Centre Hospitalier Universitaire de Poitiers (FR), Centre Hospitalier Universitaire d'Angers (FR), Centre Hospitalier Universitaire de Caen Normandie (FR), Hôpital Nord (FR), CHU Dijon Bourgogne (FR), CIC Rennes (FR), Pitié-Salpêtrière Hospital (FR), Centre Hospitalier de Gonesse (FR), Neurocentre Magendie (FR), Fondation de Rothschild (FR), Centre d'Investigation Clinique de Nantes (FR), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Hôpitaux Universitaires Henri-Mondor (FR), BP (France) (FR), Centre Hospitalier Universitaire de Martinique (MQ), Groupe Hospitalier de l'Institut Catholique de Lille (FR), Institut de Neurosciences de la Timone (FR), Hôpitaux Universitaires de Strasbourg (FR), Centre Hospitalier Saint-Denis (FR), Grenoble Institute of Neurosciences (FR), Centre Hospitalier Universitaire de Rouen (FR), Institut de Génomique Fonctionnelle (FR), Hôpital Foch (FR), Centre Hospitalier Universitaire de Saint-Étienne (FR), Hôpital Dupuytren (FR), Hôpital de la Timone (FR), Bicêtre Hospital (FR), Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes – Région Est (FR), Université d'Angers (FR), Université de Rennes (FR), Université de Rouen Normandie (FR), Université de Strasbourg (FR), Université Grenoble Alpes (FR), Université de Lorraine (FR), Université de Reims Champagne-Ardenne (FR), Nantes Université (FR), Université de Caen Normandie (FR)
Reduced inequalities
Openalex Percentile: Top 1%
Multiple Sclerosis Research Studies
36.00
DOISourceOpenAlex
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