TY - JOUR
T1 - Determinants of therapy switch in multiple sclerosis treatment-naïve patients
T2 - A real-life study
AU - Saccà, Francesco
AU - Lanzillo, Roberta
AU - Signori, Alessio
AU - Maniscalco, Giorgia T.
AU - Signoriello, Elisabetta
AU - Lo Fermo, Salvatore
AU - Repice, Annamaria
AU - Annovazzi, Pietro
AU - Baroncini, Damiano
AU - Clerico, Marinella
AU - Binello, Eleonora
AU - Cerqua, Raffaella
AU - Mataluni, Giorgia
AU - Bonavita, Simona
AU - Lavorgna, Luigi
AU - Zarbo, Ignazio Roberto
AU - Laroni, Alice
AU - Rossi, Silvia
AU - Pareja Gutierrez, Lorena
AU - La Gioia, Sara
AU - Frigeni, Barbara
AU - Barcella, Valeria
AU - Frau, Jessica
AU - Cocco, Eleonora
AU - Fenu, Giuseppe
AU - Torri Clerici, Valentina
AU - Sartori, Arianna
AU - Rasia, Sarah
AU - Cordioli, Cinzia
AU - Di Sapio, Alessia
AU - Pontecorvo, Simona
AU - Grasso, Roberta
AU - Barrilà, Caterina
AU - Russo, Cinzia Valeria
AU - Esposito, Sabrina
AU - Ippolito, Domenico
AU - Bovis, Francesca
AU - Gallo, Fabio
AU - Sormani, Maria Pia
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: With many options now available, first therapy choice is challenging in multiple sclerosis (MS) and depends mainly on neurologist and patient preferences. Objectives: To identify prognostic factors for early switch after first therapy choice. Methods: Newly diagnosed relapsing–remitting MS patients from 24 Italian centers were included. We evaluated the association of baseline demographics, clinical, and magnetic resonance imaging (MRI) data to the switch probability for lack of efficacy or intolerance/safety with a multivariate Cox analysis and estimated switch rates by competing risks models. Results: We enrolled 3025 patients. The overall switch frequency was 48% after 3 years. Switch risk for lack of efficacy was lower with fingolimod (hazard ratio (HR) = 0.50; p = 0.009), natalizumab (HR = 0.13; p < 0.001), dimethyl-fumarate (HR = 0.60; p = 0.037), teriflunomide (HR = 0.21; p = 0.031) as compared to interferons. Younger age (HR = 0.96; p < 0.001), diagnosis delay (HR = 1.23; p = 0.021), higher baseline Expanded Disability Status Scale (HR = 1.17; p = 0.001), and spinal cord lesions (HR = 1.46; p = 0.001) were independently associated with higher inefficacy switch rates. We found lower switch for intolerance/safety with glatiramer acetate (HR = 0.61; p = 0.001), fingolimod (HR = 0.35; p = 0.002), and dimethyl-fumarate (HR = 0.57; p = 0.022) as compared to interferons, while it increased with natalizumab (HR = 1.43; p = 0.022). Comorbidities were associated with intolerance switch (HR = 1.28; p = 0.047). Conclusion: Several factors are associated with higher switch risk in patients starting a first-line therapy and could be integrated in the decision-making process of first treatment choice.
AB - Background: With many options now available, first therapy choice is challenging in multiple sclerosis (MS) and depends mainly on neurologist and patient preferences. Objectives: To identify prognostic factors for early switch after first therapy choice. Methods: Newly diagnosed relapsing–remitting MS patients from 24 Italian centers were included. We evaluated the association of baseline demographics, clinical, and magnetic resonance imaging (MRI) data to the switch probability for lack of efficacy or intolerance/safety with a multivariate Cox analysis and estimated switch rates by competing risks models. Results: We enrolled 3025 patients. The overall switch frequency was 48% after 3 years. Switch risk for lack of efficacy was lower with fingolimod (hazard ratio (HR) = 0.50; p = 0.009), natalizumab (HR = 0.13; p < 0.001), dimethyl-fumarate (HR = 0.60; p = 0.037), teriflunomide (HR = 0.21; p = 0.031) as compared to interferons. Younger age (HR = 0.96; p < 0.001), diagnosis delay (HR = 1.23; p = 0.021), higher baseline Expanded Disability Status Scale (HR = 1.17; p = 0.001), and spinal cord lesions (HR = 1.46; p = 0.001) were independently associated with higher inefficacy switch rates. We found lower switch for intolerance/safety with glatiramer acetate (HR = 0.61; p = 0.001), fingolimod (HR = 0.35; p = 0.002), and dimethyl-fumarate (HR = 0.57; p = 0.022) as compared to interferons, while it increased with natalizumab (HR = 1.43; p = 0.022). Comorbidities were associated with intolerance switch (HR = 1.28; p = 0.047). Conclusion: Several factors are associated with higher switch risk in patients starting a first-line therapy and could be integrated in the decision-making process of first treatment choice.
KW - disease modifying therapies
KW - naïve
KW - persistence
KW - real-life
KW - relapsing–remitting
KW - Switch
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U2 - 10.1177/1352458518790390
DO - 10.1177/1352458518790390
M3 - Article
AN - SCOPUS:85052248047
JO - Multiple Sclerosis
JF - Multiple Sclerosis
SN - 1352-4585
ER -