Exit strategies for "needle fatigue" in multiple sclerosis: a propensity score-matched comparison study

Luca Prosperini, Antonio Cortese, Matteo Lucchini, Laura Boffa, Giovanna Borriello, Maria Chiara Buscarinu, Fioravante Capone, Diego Centonze, Chiara De Fino, Daniela De Pascalis, Roberta Fantozzi, Elisabetta Ferraro, Maria Filippi, Simonetta Galgani, Claudio Gasperini, Shalom Haggiag, Doriana Landi, Girolama Marfia, Giorgia Mataluni, Enrico MillefioriniMassimiliano Mirabella, Fabrizia Monteleone, Viviana Nociti, Simona Pontecorvo, Silvia Romano, Serena Ruggieri, Marco Salvetti, Carla Tortorella, Silvana Zannino, Giancarlo Di Battista

Research output: Contribution to journalArticlepeer-review


Patients with multiple sclerosis on long-term injectable therapies may suffer from the so-called "needle fatigue", i.e., a waning commitment to continue with the prescribed injectable treatment. Therefore, alternative treatment strategies to enhance patients' adherence are warranted. In this independent, multicentre post-marketing study, we sought to directly compare switching to either teriflunomide (TFN), dimethyl fumarate (DMF), or pegylated interferon (PEG) on treatment persistence and time to first relapse over a 12-month follow-up. We analyzed a total of 621 patients who were free of relapses and gadolinium-enhancing lesions in the year prior to switching to DMF (n = 265), TFN (n = 160), or PEG (n = 196). Time to discontinuation and time to first relapse were explored in the whole population by Cox regression models adjusted for baseline variables and after a 1:1:1 ratio propensity score (PS)-based matching procedure. Treatment discontinuation was more frequent after switching to PEG (28.6%) than DMF (14.7%; hazard ratio [HR] = 0.25, p < 0.001) and TFN (16.9%; HR = 0.27, p < 0.001). We found similar results even in the re-sampled cohort of 222 patients (74 per group) derived by the PS-based matching procedure. The highest discontinuation rate observed in PEG recipient was mainly due to poor tolerability (p = 0.005) and pregnancy planning (p = 0.04). The low number of patients who relapsed over the 12-month follow-up (25 out of 621, approximately 4%) prevented any analysis on the short-term risk of relapse. This real-world study suggests that oral drugs are a better switching option than low-frequency interferon for promoting the short-term treatment persistence in stable patients who do not tolerate injectable drugs.

Original languageEnglish
Pages (from-to)694-702
Number of pages9
JournalFront. Neurol.
Issue number3
Publication statusPublished - Mar 2020


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