Quantifying the risk of disease reactivation after interferon and glatiramer acetate discontinuation in multiple sclerosis: The VIAADISC score.
discontinuation
disease-modifying therapy
multiple sclerosis
reactivation
risk AUTHOR: Please check the list of abbreviations.
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
23
12
2020
received:
24
11
2020
accepted:
24
12
2020
pubmed:
29
12
2020
medline:
13
8
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
There is a lack of evidence guiding discontinuation of disease-modifying therapy (DMT) in relapsing multiple sclerosis (RMS). Thus, the objective of this study was to generate and validate a risk score for disease reactivation after DMT discontinuation in RMS. We drew a generation and validation dataset from two separate prospectively collected observational databases including RMS patients who received interferon-β or glatiramer acetate for ≥12 months, then discontinued DMT for ≥6 months and had ≥2 years of follow-up available. In the generation sample (n = 168), regression analysis was performed to identify clinical or magnetic resonance imaging (MRI) variables independently predicting disease reactivation after DMT discontinuation. A predictive score was calculated using the variables included in the multivariable model and applied to the validation sample (n = 98). The variables included in the final model as independent predictors of disease reactivation were age at discontinuation, MRI activity at discontinuation, and duration of clinical stability (all p < 0.001). The resulting score was able to robustly identify patients at high (83%-85%), moderate (36%-38%), and low risk (7%) of disease reactivation within 5 years after DMT discontinuation in both cohorts. The composite VIAADISC score is a valuable tool to inform and support patients and neurologists in the process of decision making to discontinue injectable DMTs.
Sections du résumé
BACKGROUND AND PURPOSE
There is a lack of evidence guiding discontinuation of disease-modifying therapy (DMT) in relapsing multiple sclerosis (RMS). Thus, the objective of this study was to generate and validate a risk score for disease reactivation after DMT discontinuation in RMS.
METHODS
We drew a generation and validation dataset from two separate prospectively collected observational databases including RMS patients who received interferon-β or glatiramer acetate for ≥12 months, then discontinued DMT for ≥6 months and had ≥2 years of follow-up available. In the generation sample (n = 168), regression analysis was performed to identify clinical or magnetic resonance imaging (MRI) variables independently predicting disease reactivation after DMT discontinuation. A predictive score was calculated using the variables included in the multivariable model and applied to the validation sample (n = 98).
RESULTS
The variables included in the final model as independent predictors of disease reactivation were age at discontinuation, MRI activity at discontinuation, and duration of clinical stability (all p < 0.001). The resulting score was able to robustly identify patients at high (83%-85%), moderate (36%-38%), and low risk (7%) of disease reactivation within 5 years after DMT discontinuation in both cohorts.
CONCLUSIONS
The composite VIAADISC score is a valuable tool to inform and support patients and neurologists in the process of decision making to discontinue injectable DMTs.
Identifiants
pubmed: 33370478
doi: 10.1111/ene.14705
pmc: PMC8248019
doi:
Substances chimiques
Glatiramer Acetate
5M691HL4BO
Interferon-beta
77238-31-4
Interferons
9008-11-1
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1609-1616Informations de copyright
© 2020 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Neurologist. 2018 Jan;23(1):12-16
pubmed: 29266038
Mult Scler. 2017 Aug;23(9):1188-1190
pubmed: 28673111
Ann Neurol. 2005 Dec;58(6):840-6
pubmed: 16283615
Mult Scler. 2020 Oct;26(12):1581-1589
pubmed: 31368401
J Neurol Neurosurg Psychiatry. 2016 Oct;87(10):1133-7
pubmed: 27298148
Eur J Neurol. 2018 Sep;25(9):1107-e101
pubmed: 29687559
J Neurol. 2021 Apr;268(4):1247-1253
pubmed: 32929591
Brain. 2016 Sep;139(Pt 9):2395-405
pubmed: 27401521
Mult Scler. 2017 Aug;23(9):1241-1248
pubmed: 27765877
Mult Scler. 2019 Apr;25(5):699-708
pubmed: 29557704
Curr Opin Neurol. 2018 Jun;31(3):233-243
pubmed: 29634596
Mult Scler Relat Disord. 2019 Oct;35:119-127
pubmed: 31374460
J Neurol. 2020 Dec;267(12):3518-3527
pubmed: 32617659
Int J MS Care. 2013 Winter;15(4):194-201
pubmed: 24453783
Continuum (Minneap Minn). 2019 Jun;25(3):715-735
pubmed: 31162313
Mult Scler Relat Disord. 2021 Jan;47:102591
pubmed: 33142245
J Neurol Sci. 2011 Apr 15;303(1-2):50-2
pubmed: 21333308
Lancet Neurol. 2018 Feb;17(2):162-173
pubmed: 29275977
PLoS One. 2016 Jul 08;11(7):e0158978
pubmed: 27391947
Mult Scler Relat Disord. 2019 May;30:252-256
pubmed: 30851638
Ann Neurol. 2011 Feb;69(2):292-302
pubmed: 21387374
J Neurol. 2014 Jun;261(6):1170-7
pubmed: 24728334
Curr Opin Neurol. 2019 Jun;32(3):365-377
pubmed: 30985372
Mult Scler. 2015 May;21(6):780-5
pubmed: 25392320
Drugs Aging. 2020 Mar;37(3):225-235
pubmed: 31916231
Mult Scler. 2009 Jul;15(7):848-53
pubmed: 19542263
Lancet. 2002 Apr 6;359(9313):1221-31
pubmed: 11955556
Nat Rev Neurol. 2019 Jun;15(6):329-342
pubmed: 31000816
Nat Rev Neurol. 2016 Dec 28;13(1):10-11
pubmed: 28028316