Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy.
Disease-modifying therapy
Multiple sclerosis
Observational comparison study
Treatment switch
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
18
09
2018
accepted:
13
11
2018
revised:
08
11
2018
pubmed:
6
12
2018
medline:
29
5
2019
entrez:
6
12
2018
Statut:
ppublish
Résumé
Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT). To compare treatment effectiveness of switch to highly effective DMT (heDMT) with switch to moderately effective DMT (meDMT) for patients who switch due to disease breakthrough defined as at least one relapse within 12 months of their treatment switch. We retrieved data from The Danish Multiple Sclerosis Registry on all relapsing-remitting MS patients with expanded disability status scale (EDSS) less than 6 who experienced disease breakthrough. We used propensity score matching to compare annualized relapse rates (ARRs), time to first confirmed relapse, time to first confirmed EDSS worsening and time to first confirmed EDSS improvement. Each matched group comprised 404 patients. Median follow-up time was 3.2 years [interquartile range (IQR) 1.7-5.8]. ARRs were 0.22 (0.19-0.27) with heDMT and 0.32 (IQR 0.28-0.37) with meDMT; relapse rate ratio was 0.70 (95% CI 0.56-0.86; p = 0.001). Escalation to heDMT reduced the hazard of reaching a first relapse (HR 0.65; 95% CI 0.53-0.80; p < 0.001). We found no evidence of delayed disability worsening (HR 0.83; 95% CI 0.62-1.10; p = 0.20) and weak evidence of disability improvement (HR 1.33; 95% CI 1.00-1.76; p = 0.05) with heDMT. Switching to heDMT is associated with reduced ARR and delay of first relapse compared with switching to meDMT. Patients on DMT who experience relapses should escalate therapy to heDMT.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT).
OBJECTIVE
OBJECTIVE
To compare treatment effectiveness of switch to highly effective DMT (heDMT) with switch to moderately effective DMT (meDMT) for patients who switch due to disease breakthrough defined as at least one relapse within 12 months of their treatment switch.
METHODS
METHODS
We retrieved data from The Danish Multiple Sclerosis Registry on all relapsing-remitting MS patients with expanded disability status scale (EDSS) less than 6 who experienced disease breakthrough. We used propensity score matching to compare annualized relapse rates (ARRs), time to first confirmed relapse, time to first confirmed EDSS worsening and time to first confirmed EDSS improvement.
RESULTS
RESULTS
Each matched group comprised 404 patients. Median follow-up time was 3.2 years [interquartile range (IQR) 1.7-5.8]. ARRs were 0.22 (0.19-0.27) with heDMT and 0.32 (IQR 0.28-0.37) with meDMT; relapse rate ratio was 0.70 (95% CI 0.56-0.86; p = 0.001). Escalation to heDMT reduced the hazard of reaching a first relapse (HR 0.65; 95% CI 0.53-0.80; p < 0.001). We found no evidence of delayed disability worsening (HR 0.83; 95% CI 0.62-1.10; p = 0.20) and weak evidence of disability improvement (HR 1.33; 95% CI 1.00-1.76; p = 0.05) with heDMT.
CONCLUSION
CONCLUSIONS
Switching to heDMT is associated with reduced ARR and delay of first relapse compared with switching to meDMT. Patients on DMT who experience relapses should escalate therapy to heDMT.
Identifiants
pubmed: 30515628
doi: 10.1007/s00415-018-9126-y
pii: 10.1007/s00415-018-9126-y
doi:
Substances chimiques
Immunologic Factors
0
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
306-315Investigateurs
Finn Sellebjerg
(F)
Melinda Magyari
(M)
Morten Blinkenberg
(M)
Annette Oturai
(A)
Jette Lautrup Frederiksen
(JL)
Alex Heick
(A)
Michael Broksgaard Jensen
(MB)
Lars Stohr
(L)
Monika Góra
(M)
Helle Hvilsted Nielsen
(HH)
Zsolt Illes
(Z)
Mathias Kant
(M)
Egon Stenager
(E)
Allan Thimsen Pedersen
(AT)
Henrik Boye Jensen
(HB)
Thor Petersen
(T)
Peter Vestergaard Rasmussen
(PV)
Lene Rosendahl
(L)
Jesper Tørring
(J)
Claudia Christina Pfleger
(CC)
Arkadiusz Weglewski
(A)
Références
Neurology. 2004 Dec 14;63(11 Suppl 5):S42-9
pubmed: 15596736
N Engl J Med. 2006 Mar 2;354(9):899-910
pubmed: 16510744
N Engl J Med. 2006 Mar 2;354(9):911-23
pubmed: 16510745
Eur J Neurol. 2006 May;13(5):471-4
pubmed: 16722971
Eur J Neurol. 2008 Apr;15(4):386-93
pubmed: 18353125
Mult Scler. 2009 Jan;15(1):50-8
pubmed: 18922831
Mult Scler. 2009 May;15(5):601-5
pubmed: 19299439
N Engl J Med. 2010 Feb 4;362(5):387-401
pubmed: 20089952
N Engl J Med. 2010 Feb 4;362(5):402-15
pubmed: 20089954
J Neurol Sci. 2010 May 15;292(1-2):28-35
pubmed: 20236661
N Engl J Med. 2011 Oct 6;365(14):1293-303
pubmed: 21991951
N Engl J Med. 2012 Sep 20;367(12):1087-97
pubmed: 22992072
Lancet. 2012 Nov 24;380(9856):1829-39
pubmed: 23122650
Lancet. 2012 Nov 24;380(9856):1819-28
pubmed: 23122652
J Neurol. 2013 Sep;260(9):2297-305
pubmed: 23797999
Lancet Neurol. 2014 Mar;13(3):247-56
pubmed: 24461574
Lancet Neurol. 2014 Jun;13(6):545-56
pubmed: 24685276
Curr Opin Neurol. 2014 Jun;27(3):246-59
pubmed: 24759080
JAMA Neurol. 2015 Apr;72(4):405-13
pubmed: 25665031
Ann Clin Transl Neurol. 2015 Apr;2(4):373-87
pubmed: 25909083
World J Clin Cases. 2015 Jul 16;3(7):545-55
pubmed: 26244148
J Neurol. 2016 Feb;263(2):327-333
pubmed: 26645389
Ther Adv Neurol Disord. 2016 Jan;9(1):44-52
pubmed: 26788130
Mult Scler. 2017 Feb;23(2):234-241
pubmed: 27055806
J Neurol. 2016 Sep;263(9):1802-9
pubmed: 27314964
Autoimmun Rev. 2017 Jun;16(6):658-665
pubmed: 28428119
Neurology. 1995 Jul;45(7):1268-76
pubmed: 7617181
Neurology. 1993 Apr;43(4):655-61
pubmed: 8469318
Ann Neurol. 1996 Mar;39(3):285-94
pubmed: 8602746
Lancet. 1998 Nov 7;352(9139):1498-504
pubmed: 9820297