TOPLINE

Among patients with relapsing-remitting multiple sclerosis (RRMS), oral and injectable platform disease-modifying therapies (DMTs) showed no significant differences in the risk for progression independent of relapse activity (PIRA).

METHODOLOGY

• Researchers conducted a retrospective, observational study using data from the Italian MS register to compare the risk for PIRA among patients with RRMS who were treated with oral and injectable platform DMTs.
• They analysed 1910 patients with RRMS who were continuously treated for at least 5 years with oral DMTs (dimethyl fumarate, n = 465; teriflunomide, n = 196) and injectable DMTs (interferon beta, n = 824; glatiramer acetate, n = 425), without a switch or interruption, and underwent at least three assessments using the Expanded Disability Status Scale (EDSS).
• PIRA was defined as confirmed disability worsening on the EDSS that was sustained for at least 12 months, occurred without clinical relapses, and was not accompanied by any relapse in the 30 days before the EDSS assessment.
• Propensity score matching was performed to account for baseline differences, yielding matched pairs for oral (dimethyl fumarate vs teriflunomide; n = 174), injectable (interferon beta vs glatiramer acetate; n = 404), and oral vs injectable (n = 621) treatment comparisons.
• Outcomes were the number of PIRA events and the time to the first event. Additional analyses of the time to the first PIRA event were performed in expanded cohorts, irrespective of treatment duration.

TAKEAWAY

• No significant difference in the number of PIRA events and the time to the first event was noted between patients treated with dimethyl fumarate and teriflunomide.
• Likewise, no significant difference emerged between interferon beta and glatiramer acetate in terms of the number of PIRA events or the time to the first event.
• In the pooled comparison, oral and injectable platform DMTs did not differ significantly in the number of PIRA events or the time to the first event.
• An additional analysis in the expanded cohort, without treatment duration restrictions, also showed no difference in the time to the first PIRA event in any of the three comparisons.

IN PRACTICE

"In the absence of demonstrated differences in protection against relapse-independent progression, the choice among platform DMTs should continue to rely on other considerations including tolerability, safety profile, patient comorbidities, laboratory monitoring requirements, route of administration, family planning, and patient preferences," the authors wrote.

SOURCE

The study was led by Leonardo Palazzo, Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy. It was published online on October 05, 2026, in the Journal of Neurology.

LIMITATIONS

Because of the retrospective nature of the study, the possibility of information bias could not be completely ruled out. The need for at least 5 years of continuous treatment may have introduced selection bias. The specific reasons for discontinuing treatment were not provided.

DISCLOSURES

The study did not receive any specific funding. Several authors declared receiving consulting fees, speaker honoraria, research support, compensation for speaking activities, or travel grants and participating in advisory boards of different pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.