Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies

6533b832fe1ef96bd129a2ac

RESEARCH PRODUCT

Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies

Eleonora Cocco Antonella Conte Pietro Iaffaldano Vincenzo Brescia Morra Marco Rovaris Giorgia Teresa Maniscalco Claudio Gasperini Mauro Zaffaroni Rocco Totaro Marco Capobianco Marco Salvetti Damiano Paolicelli F Caputo Maria Trojano Franco Granella Elio Scarpini Giuseppe Salemi Paolo Bellantonio Italian Ms Register Matilde Inglese Roberto Bergamaschi Giancarlo Comi Davide Maimone Francesco Patti Giovanna De Luca 2 Giacomo Lus Patrizia Sola Valentina Torri Clerici Giuseppe Lucisano Carlo Pozzilli Massimo Filippi Maria Pia Amato

subject

Pediatrics medicine.medical_specialty big data; disability trajectories; disease registry; multiple sclerosis.multiple sclerosis 03 medical and health sciences 0302 clinical medicine Disease registry big data Medicine 030212 general & internal medicine RC346-429 Original Research big data; disability trajectories; disease registry; multiple sclerosis Pharmacology business.industry Multiple sclerosis Long term disability medicine.disease Neurology disease registry Treatment strategy Settore MED/26 - Neurologia disability trajectories Neurology. Diseases of the nervous system Neurology (clinical)business 030217 neurology & neurosurgery

description

Background and aims: No consensus exists on how aggressively to treat relapsing–remitting multiple sclerosis (RRMS) nor on the timing of the treatment. The objective of this study was to evaluate disability trajectories in RRMS patients treated with an early intensive treatment (EIT) or with a moderate-efficacy treatment followed by escalation to higher-efficacy disease modifying therapy (ESC). Methods: RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the Italian MS Registry. EIT group included patients who received as first DMT fingolimod, natalizumab, mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients received the high efficacy DMT after ⩾1 year of glatiramer acetate, interferons, azathioprine, teriflunomide or dimethylfumarate treatment. Patients were 1:1 propensity score (PS) matched for characteristics at the first DMT. The disability trajectories were evaluated by applying a longitudinal model for repeated measures. The effect of early versus late start of high-efficacy DMT was assessed by the mean annual Expanded Disability Status Scale (EDSS) changes compared with baseline values (delta-EDSS) in EIT and ESC groups. Results: The study cohort included 2702 RRMS patients. The PS matching procedure produced 363 pairs, followed for a median (interquartile range) of 8.5 (6.5–11.7) years. Mean annual delta-EDSS values were all significantly ( p < 0.02) higher in the ESC group compared with the EIT group. In particular, the mean delta-EDSS differences between the two groups tended to increase from 0.1 (0.01–0.19, p = 0.03) at 1 year to 0.30 (0.07–0.53, p = 0.009) at 5 years and to 0.67 (0.31–1.03, p = 0.0003) at 10 years. Conclusion: Our results indicate that EIT strategy is more effective than ESC strategy in controlling disability progression over time.

year	journal	country	edition	language
2021-05-01	Therapeutic Advances in Neurological Disorders

https://doi.org/10.1177/17562864211019574