Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy. / Members of Danish Multiple Sclerosis Group ; Sellebjerg, Finn Thorup; Magyari, Melinda; Blinkenberg, Morten; Oturai, Annette Bang; Fredriksen, Jette Lautrup; Jensen, Michael Broksgaard; Tørring, Jesper; Pfleger, Claudia Christina; Weglewski, Arkadiusz.
I: Journal of Neurology, Bind 266, Nr. 2, 02.2019, s. 306-315.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy
AU - Chalmer, Thor Ameri
AU - Kalincik, Tomas
AU - Laursen, Bjarne
AU - Sorensen, Per Soelberg
AU - Magyari, Melinda
AU - Members of Danish Multiple Sclerosis Group
AU - Sellebjerg, Finn Thorup
AU - Magyari, Melinda
AU - Blinkenberg, Morten
AU - Oturai, Annette Bang
AU - Fredriksen, Jette Lautrup
AU - Jensen, Michael Broksgaard
AU - Tørring, Jesper
AU - Pfleger, Claudia Christina
AU - Weglewski, Arkadiusz
PY - 2019/2
Y1 - 2019/2
N2 - BACKGROUND: Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT).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: 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: 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: 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.
AB - BACKGROUND: Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT).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: 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: 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: 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.
KW - Adult
KW - Denmark
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Immunologic Factors/administration & dosage
KW - Immunotherapy/methods
KW - Male
KW - Middle Aged
KW - Multiple Sclerosis, Relapsing-Remitting/drug therapy
KW - Outcome Assessment, Health Care
KW - Recurrence
KW - Registries
KW - Severity of Illness Index
KW - Sex Factors
U2 - 10.1007/s00415-018-9126-y
DO - 10.1007/s00415-018-9126-y
M3 - Journal article
C2 - 30515628
VL - 266
SP - 306
EP - 315
JO - Deutsche Zeitschrift fur Nervenheilkunde
JF - Deutsche Zeitschrift fur Nervenheilkunde
SN - 0939-1517
IS - 2
ER -
ID: 235472267