Higher-Efficacy DMTs May Have Favorable Effect on Depression in MS

Kathryn C. Fitzgerald, ScD

Initiating multiple sclerosis (MS) treatment with high-efficacy disease-modifying therapies (DMTs) may help reduce depressive symptoms, according to interim study results presented at the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), May 28 through June 1 in Seattle, Washington.

Given that depression is a common symptom in patients with MS and is associated with increased morbidity and mortality, investigators led by Kathryn C. Fitzgerald, ScD, assistant professor of neurology at Johns Hopkins School of Medicine, examined the effects of lower-efficacy DMTs and higher-efficacy DMTs on depression. The investigators hypothesized that higher-efficacy DMTs may exert antidepressive properties given their strong anti-inflammatory effects.

The investigators analyzed data from the ongoing, 10-site MS PATHS longitudinal study to compare rates of change in depressive symptoms measured by the Quality of Life in Neurological Disorders (Neuro-QoL) depressive subscale in patients with relapsing-remitting MS who initiated a new DMT.

They categorized lower-efficacy DMTs as interferons, glatiramer acetate, fingolimod, and dimethyl fumarate. Higher-efficacy DMTs included natalizumab, rituximab, ocrelizumab, and alemtuzumab.

Upon interim analysis, 1740 patients (mean age, 45.1±12.3 years; 76% female; mean follow-up, 0.92±0.48 years) had initiated a new DMT (lower-efficacy, n = 922; higher-efficacy, n = 579). Compared with lower-efficacy DMTs, initiation of MS treatment with higher-efficacy DMTs was associated with a multivariate-adjusted point/ y reduction of 0.58 in Neuro-QoL scores (95% CI, -1.05 - -0.11; P =.01). Results remained consistent after excluding interferons from the lower-efficacy DMT group (-0.63 reduction; 95% CI, -1.09 - -0.13; P =.01).

While additional follow-up is necessary to confirm the interim findings, the investigators concluded that higher-efficacy DMTs appear to have a favorable effect on depressive symptoms in patients with MS.

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REFERENCE

Roh YS, Mowry EM, Fitzgerald KC. Initiation of higher-efficacy disease-modifying therapy and depressive symptom evolution in patients with multiple sclerosis. Presented at: 2019 CMSC Annual Meeting. May 28-June 1, 2019; Seattle, WA. Abstract DXT62.