Clinical predictors of response to immunomodulators for multiple sclerosis

Abstract

Multiple sclerosis (MS) is an autoimmune disease characterized by demyelinating inflammatory activity of the central nervous system. It is most prevalent in young adults between 20 and 40 years of age and constitutes a frequent cause of neurological dysfunction in this age group 1 .Immunomodulatory therapy had been proven to be effective in modifying the natural course of the disease in patients with MS. Interferon beta (IFNb) and glatiramer acetate (GA) comprise the first line of therapy for MS and have seemed to reduce the rate of demyelination exacerbations compared to placebo in clinical trials 2-5 . However, not all patients are responsive to this treatment 6 . ABStrActObjectives: To determine, based on clinical criteria, the proportion of multiple sclerosis (MS) patients responsive to immunomodulators (RI) and nonresponsive to immunomodulators (NRI), and to ascertain whether clinical and epidemiological data differs between RI and NRI patient groups. Methods: Patients were assessed on rate of exarcerbations per year, for the period before and after commencement of treatment. The RI and NRI groups were compared for several clinical and epidemiological characteristics. Discussion and conclusion: A total of 31.4% of the patients were nonresponders to the immunomodulatory treatment. The main predictors of immunomodulatory response were early diagnostic and commencement of therapy and high rate of annual exacerbations prior to treatment. Given the arsenal of medication options available for MS management, screening potential candidates for different therapeutic approaches are critical to optimize evolution of patients with the disease.Key words: multiple sclerosis, immunomodulators, predictors. reSUMO Objetivos: Avaliar por meio de critérios clínicos, a proporção de pacientes com esclerose múltipla (EM) responsivos aos imunomoduladores (RI) e não responsivos aos imunomoduladores (NRI) e avaliar se dados clínicos e epidemiológicos são distintos nesses dois grupos. Méto-dos: Os pacientes foram avaliados quanto à taxa de surtos por ano no período antes e após o início do tratamento. Diversas características clínicas e epidemiológicas foram comparadas entre os pacientes RI e NRI. Discussão e conclusão: Em nossa população, 31,4% dos pacientes não responderam ao tratamento com os imunomoduladores. Os principais preditores de resposta aos imunomoduladores foram: diagnóstico e início precoce da terapia e elevada taxa de surtos anual antes do tratamento. Como existem várias opções medicamentosas disponíveis para o tratamento da EM, a identificação de candidatos potenciais para abordagens terapêuticas diferentes representa o ponto crucial para otimizar a evolução dos pacientes com essa doença.Palavras-Chave: esclerose múltipla, imunomoduladores, preditores.

Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis

“…approximately 70% of patients with MS respond to treatment with immunomodulatory drugs, our group have demonstrated that the most effective use of DMT occurs in patients with high attack rates 5 . These medications do not seek to eliminate the occurrence of attacks but to diminish their frequency 6,7 .…”

Professor Emeritus Charles Peter Tilbery [1944-2020]

“…Aspects related to the treatment of MS, such as drug migration, treatment failure, and adverse effects of immunomodulatory drugs in Brazilian patients 21,22,23,24 .…”

Development of systemic sarcoidosis and xanthoma planum during multiple sclerosis treatment with interferon‐beta 1a: Case Report

“…Immunomodulating therapies are proving to be effective in changing the natural course of the disease in patients with MS . The introduction of immunomodulators such as interferon‐beta (IFN‐B) produced a reduction in the severity and frequency of the attacks …”