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The following is a summary of “Secondary progression activity monitoring in MS despite an early highly active treatment the SPAM study,” published in the May 2025 issue of European Journal of Neurology by Cohen et al. 

Real-world data suggested that early initiation of highly active therapies (HAT) could reduce the risk of progression to secondary progressive multiple sclerosis (SPMS), but knowledge of predictive factors for outcomes was limited.  

Researchers conducted a retrospective study to determine the factors among individuals linked with the development of SPMS who were treated early with HAT after the onset of multiple sclerosis (MS).  

They used the French MS database to include patients who initiated HAT within 5 years of MS onset, had an EDSS score of ≤4, and had a follow-up period of >5 years. The association between baseline covariates and time to SPMS occurrence was evaluated by hazard ratios (HRs) using unadjusted and adjusted Cox proportional hazards models.  

The results showed that 2,237 patients were included, with a mean age of 31.6 years, a female-to-male sex ratio of 2.3, and a median EDSS score of 2.0. At 10 years, the estimated probability of reaching secondary progressive multiple sclerosis, progression independent of relapse activity (PIRA), and progression independent of activity (PIA) was 8%, 22%, and 11%, respectively. After adjustment, female patients (hazard ratio [HR] 0.64, P= 0.036) had a lower risk of developing SPMS. Older age, EDSS >0 (HR 7.44, P< 0.001), and oral vs intravenous HAT (HR 1.97, P= 0.003) were significantly associated with an increased risk of SPMS and Early PIRA and PIA predicted the conversion to SPMS.  

Investigators concluded that early use of HAT resulted in a low risk of developing SPMS over 10 years and initiating HAT before any residual disability was associated with a lower risk of progression. 

Source: onlinelibrary.wiley.com/doi/10.1111/ene.16583