Abstract:
BACKGROUND:The increase in disease-modifying drugs (DMDs) allows individualization of treatment in relapsing multiple sclerosis (RMS); however, the long-term impact of different treatment sequences is not well established. This is particularly relevant for MS patients who may need to postpone more aggressive DMD strategies. OBJECTIVE:To evaluate different therapeutic strategies and their long-term outcomes, measured as relapses and confirmed disability progression (CDP), in MS 'real-world' settings. METHODS:Multicentre, observational, retrospectively acquired cohort study evaluating the long-term impact of different treatment strategies on disability outcomes in patients with RMS in the Italian MS Register. RESULTS:We evaluated 1152 RMS-naïve patients after propensity-score adjustment. Patients included were receiving: interferon beta-1a (IFN-β1a) 44 µg switching to fingolimod (FTY; IFN-switchers; n = 97); FTY only (FTY-stayers; n = 157); IFN-β1a only (IFN-stayers; n = 849). CDP and relapses did not differ between FTY-stayers and IFN-switchers [HR (95% CI) 0.99 (0.48-2.04), p = 0.98 and 0.81 (0.42-1.58), p = 0.55, respectively]. However, IFN-stayers showed increased risk of relapses compared with FTY-stayers [HR (95% CI) 1.46 (1.00-2.12), p = 0.05]. CONCLUSION:The ideal treatment option for MS is becoming increasingly complex, with the need to balance benefit and risks. Our results suggest that starting with FTY affects the long-term disease outcome similarly to escalating from IFN-β1a to FTY.
journal_name
J Neuroljournal_title
Journal of neurologyauthors
Paolicelli D,Lucisano G,Manni A,Avolio C,Bonavita S,Brescia Morra V,Capobianco M,Cocco E,Conte A,De Luca G,De Robertis F,Gasperini C,Gatto M,Gazzola P,Lus G,Iaffaldano A,Iaffaldano P,Maimone D,Mallucci G,Maniscalcodoi
10.1007/s00415-019-09531-6subject
Has Abstractpub_date
2019-12-01 00:00:00pages
3098-3107issue
12eissn
0340-5354issn
1432-1459pii
10.1007/s00415-019-09531-6journal_volume
266pub_type
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