Stable Disability in Progressive Multiple Sclerosis With Teriflunomide

The following article is part of live conference coverage from the 2018 ACTRIMS Forum in San Diego, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from ACTRIMS 2018.

Teriflunomide 14 mg is associated with long-term stable disability in progressive forms of relapsing multiple sclerosis (RMS), according to research presented at the 2018 ACTRIMS Forum in San Diego, California.¹

“Recent clinical trials have reported positive outcomes in patients with progressive forms of MS treated with some disease-modifying therapies.^2,3 However, a significant unmet need remains for an effective, well-tolerated, and convenient treatment for patients with progressive forms of MS,” wrote Regina Berkovich, MD, PhD, from the USC MS Comprehensive Care Center & Research Group in Los Angeles, and colleagues.

To examine the efficacy of teriflunomide in patients with progressive forms of RMS, researchers collected clinical and magnetic resonance imaging outcomes retrospectively from 23 patients with progressive forms of RMS treated with teriflunomide in 2 large MS centers in the United States: 13 from the University of Texas in Houston MS Research Group and 10 from the University of Southern California MS Comprehensive Care Center and Research Group in Los Angeles.

Of the 23 patients, 22 had a diagnosis of secondary progressive MS (n=22), defined as disability worsening of at least 1 point on the Expanded Disability Status Scale (EDSS) over the previous 5 years in the absence of relapses, and 1 patient was diagnosed with progressive relapsing MS. The mean (range) disease duration since diagnosis was 20.1 (7-37) years, and the mean (range) baseline EDSS score was 5.4 (2-6.5). All patients had received prior disease-modifying therapy before initiation of teriflunomide, the majority with an injectable (interferon, glatiramer acetate). Patients were treated with teriflunomide for 3 to 5 years; 22 were treated with teriflunomide 14 mg and 1 was treated with teriflunomide 7 mg.

At the last visit, EDSS scores ranged from 2 to 7.5. In 82.6% of patients (n=19), EDSS scores remained stable compared with baseline. Scores for 4 of the patients worsened (from 5.0 to 6.0, 6.0 to 6.5, 6.5 to 7.0, and 7.0 to 7.5), and this worsening in disability corresponded to worsening on magnetic resonance imaging in 3 of the patients. Two of the patients who had worsening scores had interrupted teriflunomide treatment.

“These real-world observational outcomes provide supportive evidence that treatment with teriflunomide 14 mg is associated with long-term stable disability in patients with progressive forms of [relapsing MS],” the researchers concluded. “Prospective studies in [secondary progressive] MS are needed to confirm these findings.”

Disclosures: This study was supported by Sanofi. Karthinathan Thangavelu, Steve Cavalier, and Philippe Truffinet are employees of Sanofi. Flavia Nelson reports consulting and honoraria fees from Acorda, Bayer HealthCare, CMSC, Genentech, Mylan, Novartis, Sanofi Genzyme, and Teva Neuroscience, and research support from Alkermes, National MS Society, and Novartis.

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References

1. Berkovich R, Thangavelu K, Cavalier SJ, Truffinet P, Nelson F. Long-term outcomes in patients with progressive forms of relapsing MS treated with teriflunomide: real-world evidence. Presented at: ACTRIMS Forum 2018; February 1-3, 2018; San Diego, CA. Poster 022.
2. Montalban X, Houser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med. 2017;376:209-220.
3. Kappos L, Bar-Or A, Cree B, et al. Efficacy and safety of siponimod in secondary progressive multiple sclerosis – results of the placebo controlled, double-blind, phase III EXPAND study. Presented at: ECTRIMS 2016; September 14-17, 2016; London, UK. Abstract 250.