Effect of Disease-Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years.
Adult
Disability Evaluation
Disease Progression
Female
Fingolimod Hydrochloride
/ therapeutic use
Glatiramer Acetate
/ therapeutic use
Humans
Immunologic Factors
/ therapeutic use
Immunosuppressive Agents
/ therapeutic use
Interferon-beta
/ therapeutic use
Longitudinal Studies
Male
Middle Aged
Multiple Sclerosis, Relapsing-Remitting
/ drug therapy
Natalizumab
/ therapeutic use
Proportional Hazards Models
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
02 02 2021
02 02 2021
Historique:
received:
13
06
2019
accepted:
23
09
2020
pubmed:
30
12
2020
medline:
23
2
2021
entrez:
29
12
2020
Statut:
ppublish
Résumé
To test the hypothesis that immunotherapy prevents long-term disability in relapsing-remitting multiple sclerosis (MS), we modeled disability outcomes in 14,717 patients. We studied patients from MSBase followed for ≥1 year, with ≥3 visits, ≥1 visit per year, and exposed to MS therapy, and a subset of patients with ≥15-year follow-up. Marginal structural models were used to compare the cumulative hazards of 12-month confirmed increase and decrease in disability, Expanded Disability Status Scale (EDSS) step 6, and the incidence of relapses between treated and untreated periods. Marginal structural models were continuously readjusted for patient age, sex, pregnancy, date, disease course, time from first symptom, prior relapse history, disability, and MRI activity. A total of 14,717 patients were studied. During the treated periods, patients were less likely to experience relapses (hazard ratio 0.60, 95% confidence interval [CI] 0.43-0.82, Continued treatment with MS immunotherapies reduces disability accrual by 19%-44% (95% CI 1%-62%), the risk of need of a walking aid by 67% (95% CI 41%-81%), and the frequency of relapses by 40-41% (95% CI 18%-57%) over 15 years. This study provides evidence that disease-modifying therapies are effective in improving disability outcomes in relapsing-remitting MS over the long term. This study provides Class IV evidence that, for patients with relapsing-remitting MS, long-term exposure to immunotherapy prevents neurologic disability.
Identifiants
pubmed: 33372028
pii: WNL.0000000000011242
doi: 10.1212/WNL.0000000000011242
pmc: PMC7884998
doi:
Substances chimiques
Immunologic Factors
0
Immunosuppressive Agents
0
Natalizumab
0
Glatiramer Acetate
5M691HL4BO
Interferon-beta
77238-31-4
Fingolimod Hydrochloride
G926EC510T
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e783-e797Investigateurs
Gerardo Iuliano
(G)
Thor Petersen
(T)
Freek Verheul
(F)
Norbert Vella
(N)
Krisztina Kovacs
(K)
Tatjana PetkovskaBoskova
(T)
Tunde Erdelyi
(T)
Eniko Dobos
(E)
Ricardo Fernandez Bolaños
(RF)
Ilya Kister
(I)
Jose Antonio Cabrera-Gomez
(JA)
Etienne Roullet
(E)
Cees Zwanikken
(C)
Leontien Den Braber-Moerland
(L)
Norma Der
(N)
Alfredo Firstenfeld
(A)
Elizabeth Alejandra Bacile
(EA)
Vetere Santiago
(V)
Carlos Vrech S
(C)
Todd Hardy
(T)
Walter Oleschko Arruda
(WO)
Stephane Charest
(S)
Celia Oreja-Guevara
(C)
Gavin McDonnell
(G)
Gabor Rum
(G)
Shlomo Flechter
(S)
Dheeraj Khurana
(D)
Maria Pia Amato
(MP)
Vladimir Bojkovski
(V)
Erik van Munster
(E)
Maria Edite Rio
(ME)
Talal Al-Harbi
(T)
Jodi Haartsen
(J)
Informations de copyright
© 2020 American Academy of Neurology.
Références
Mult Scler. 2013 Jul;19(8):1074-83
pubmed: 23234810
Mult Scler. 2017 Apr;23(5):647-655
pubmed: 27481209
Mult Scler. 2016 Nov;22(13):1642-1648
pubmed: 27270498
JAMA Neurol. 2018 Nov 1;75(11):1407-1415
pubmed: 30083762
Lancet Neurol. 2019 Oct;18(10):973-980
pubmed: 31375366
Neurology. 2017 Sep 5;89(10):1050-1059
pubmed: 28794248
JAMA Neurol. 2020 Nov 1;77(11):1398-1407
pubmed: 32716480
J Neurol Neurosurg Psychiatry. 2019 Mar;90(3):251-260
pubmed: 30242090
Neurology. 2006 Mar 14;66(5):678-84
pubmed: 16436649
Mult Scler. 2017 Apr;23(4):597-603
pubmed: 27364325
Mult Scler. 2019 Dec;25(14):1828-1834
pubmed: 31120376
PLoS One. 2011;6(11):e22444
pubmed: 22140424
Cochrane Database Syst Rev. 2015 Sep 18;(9):CD011381
pubmed: 26384035
Ann Clin Transl Neurol. 2015 May;2(5):479-91
pubmed: 26000321
Nat Rev Neurol. 2012 Nov 5;8(11):647-56
pubmed: 23007702
J Epidemiol Community Health. 2004 Apr;58(4):265-71
pubmed: 15026432
Lancet Neurol. 2020 Apr;19(4):307-316
pubmed: 32199096
Ann Neurol. 2005 Dec;58(6):840-6
pubmed: 16283615
Neurology. 2016 Sep 6;87(10):978-87
pubmed: 27511182
Neurology. 2012 Apr 24;78(17):1315-22
pubmed: 22496198
JAMA. 2012 Jul 18;308(3):247-56
pubmed: 22797642
Ann Neurol. 2011 Feb;69(2):292-302
pubmed: 21387374
N Engl J Med. 2008 Oct 23;359(17):1786-801
pubmed: 18946064
Int J Epidemiol. 2002 Apr;31(2):422-9
pubmed: 11980807
Mult Scler. 2017 Aug;23(9):1233-1240
pubmed: 27754943
Lancet. 2005 Jul 30-Aug 5;366(9483):378-84
pubmed: 16054937
N Engl J Med. 2006 Mar 2;354(9):899-910
pubmed: 16510744
Brain. 2015 Nov;138(Pt 11):3287-98
pubmed: 26359291
Am J Epidemiol. 2004 May 15;159(10):926-34
pubmed: 15128604
Int MS J. 2009 Sep;16(3):90-7
pubmed: 19878631
Lancet Neurol. 2015 May;14(5):497-505
pubmed: 25841667
Epidemiology. 2000 Sep;11(5):550-60
pubmed: 10955408
Ann Neurol. 2016 Jul;80(1):89-100
pubmed: 27145331
Ann Neurol. 2007 Apr;61(4):300-6
pubmed: 17444502
Am J Epidemiol. 2014 Jul 15;180(2):160-71
pubmed: 24939980
N Engl J Med. 2010 Feb 4;362(5):387-401
pubmed: 20089952
N Engl J Med. 2017 Jan 19;376(3):221-234
pubmed: 28002679