TY - JOUR
T1 - 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
T2 - Journal of Neurology
AU - Paolicelli, D
AU - Lucisano, G
AU - Manni, A
AU - Avolio, C
AU - Bonavita, S
AU - Brescia Morra, V
AU - Capobianco, M
AU - Cocco, E
AU - Conte, A
AU - De Luca, G
AU - De Robertis, F
AU - Gasperini, C
AU - Gatto, M
AU - Gazzola, P
AU - Lus, G
AU - Iaffaldano, A
AU - Iaffaldano, P
AU - Maimone, D
AU - Mallucci, G
AU - Maniscalco, GT
AU - Marfia, GA
AU - Patti, F
AU - Pesci, I
AU - Pozzilli, C
AU - Rovaris, M
AU - Salemi, G
AU - Salvetti, M
AU - Spitaleri, D
AU - Totaro, R
AU - Zaffaroni, M
AU - Comi, G
AU - Amato, MP
AU - Trojano, M
AU - Register, on behalf of the Italian MS
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
U2 - 10.1007/s00415-019-09531-6
DO - 10.1007/s00415-019-09531-6
M3 - Article
VL - 266
SP - 3098
EP - 3107
JO - Journal of Neurology
JF - Journal of Neurology
SN - 0340-5354
ER -