Retrospectively acquired cohort study to evaluate the long-term impact of two different treatment strategies on disability outcomes in patients with relapsing multiple sclerosis (RE.LO.DI.MS): data from the Italian MS Register: Journal of Neurology

D Paolicelli, G Lucisano, A Manni, C Avolio, S Bonavita, V Brescia Morra, M Capobianco, E Cocco, A Conte, G De Luca, F De Robertis, C Gasperini, M Gatto, P Gazzola, G Lus, A Iaffaldano, P Iaffaldano, D Maimone, G Mallucci, GT ManiscalcoGA Marfia, F Patti, I Pesci, C Pozzilli, M Rovaris, G Salemi, M Salvetti, D Spitaleri, R Totaro, M Zaffaroni, G Comi, MP Amato, M Trojano, on behalf of the Italian MS Register

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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. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
Original languageEnglish
Pages (from-to)3098-3107
Number of pages10
JournalJournal of Neurology
Volume266
DOIs
Publication statusPublished - 2019

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