Achievement of No Evidence of Disease Activity-3 with Oral Disease-Modifying Treatment in Patients with Relapsing-Remitting Multiple Sclerosis

Foziah Jabbar Gossab Alshamrani; Azra Zafar; Rahmah Majed Alsawad; Zakia Yasawy; Rizwana Shahid; Saima Nazish; Erum Shariff; Nehad Mahmoud Soltan

doi:10.4103/sjmms.sjmms_148_24

Achievement of No Evidence of Disease Activity-3 with Oral Disease-Modifying Treatment in Patients with Relapsing-Remitting Multiple Sclerosis

Saudi J Med Med Sci. 2024 Oct-Dec;12(4):299-305. doi: 10.4103/sjmms.sjmms_148_24. Epub 2024 Oct 12.

Authors

Foziah Jabbar Gossab Alshamrani¹, Azra Zafar¹, Rahmah Majed Alsawad², Zakia Yasawy¹, Rizwana Shahid¹, Saima Nazish¹, Erum Shariff¹, Nehad Mahmoud Soltan¹

Affiliations

¹ Department of Neurology, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, King Fahd Hospital of the University, Al Khobar, Saudi Arabia.
² College of Medicine, Dar Aluloom University, Riyadh, Saudi Arabia.

Abstract

Background: There is scant data regarding the use of oral disease-modifying treatments (oDMT) in patients with relapsing-remitting multiple sclerosis (PwRRMS) from Saudi Arabia.

Objective: This study aimed to identify the response rate to oDMT in PwRRMS compared to interferon (IFN) in terms of achieving no evidence of disease activity-3 (NEDA-3).

Methods: This retrospective study was conducted at a tertiary care hospital in Saudi Arabia and included all adult PwRRMS over a 2-year period who were on oDMTs or IFN for <1 year. The achievement of overall NEDA-3 and its components (namely, relapse, disability progression, and focal MRI activity) were assessed for each treatment.

Results: A total of 231 patients were included for the analysis of NEDA-3 status, of which 78 (33.8%) were on oDMTs (namely, dimethyl fumarate, teriflunomide, and fingolimod). NEDA-3 status was achieved in 51.3% (OR: 1.86, 95% CI: 1.28-2.71) of patients on oDMTs and in 32% of patients on IFN (OR: 0.72, 95% CI: 0.58-0.89) (P < 0.001). Compared to the IFN group, the oDMT group had significantly lower rates of clinical relapse (P < 0.001), disability progression (P = 0.004), and new focal MRI activity (P = 0.01). Patients on dimethyl-fumarate had higher odds of achieving NEDA-3 (OR: 2.18, 95% CI = 1.09-4.34; P =0.02) compared with those on fingolimod (OR 2.15, 95% CI = 0.70-6.58; P =0.16) and teriflunomide (OR: 1.53, 95% CI = 0.81-2.91; P =0.18).

Conclusion: More than half of the patients with relapsing-remitting multiple sclerosis on oral DMTs achieved NEDA-3 status in this study. Significant differences were observed in NEDA-3 status parameters and achievement between patients on oral DMTs and interferon, with the likeliness being highest among patients treated with dimethyl-fumarate.

Keywords: Disease modifying treatment; Saudi Arabia; interferon; oral; prognosis; relapsing–remitting multiple sclerosis.