Switching to second line MS disease-modifying therapies is associated with decreased relapse rate.
| Autor: | Marriott JJ; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada., Ekuma O; Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada., Fransoo R; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada., Marrie RA; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.; Section of Neurology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. |
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| Jazyk: | angličtina |
| Zdroj: | Frontiers in neurology [Front Neurol] 2023 Sep 06; Vol. 14, pp. 1243589. Date of Electronic Publication: 2023 Sep 06 (Print Publication: 2023). |
| DOI: | 10.3389/fneur.2023.1243589 |
| Abstrakt: | Background and Objectives: While randomized, controlled trials (RCTs) are the gold standard for determining treatment efficacy, they do not capture the effectiveness of treatment during real-world use. We aimed to evaluate the association between demographics and multiple sclerosis (MS) disease-modifying therapy (DMT) exposure, including treatment adherence and switches between different DMTs, on the risk of subsequent MS relapse. Methods: All persons with relapsing-onset MS (pwRMS) living in Manitoba between 1999 and 2014 were identified from provincial healthcare databases using a validated case definition. Use of DMTs was abstracted from the provincial drug database covering all residents of Manitoba, including use of any DMT, stopping/starting any DMT, switches between different DMTs and adherence as defined by cumulative medication possession ratios (CUMMPRs) of 50, 70, 80 and 90%. Time to first-treated relapse was used as the outcome of interest in logistic regression and Cox-proportional hazards regression models adjusting for demographic covariates including age and year of diagnosis, sex, socioeconomic status and number of medical comorbidities. Results: 1780 pwRMS were identified, including 1,510 who were on DMT at some point in the study period. While total DMT exposure was not associated with the time to subsequent treated relapse, individuals who switched between more than 2 DMTs had higher post-switch rates of relapse. Switching to second-line DMTs was associated with a longer time to treated relapse in comparison to those who remained on a first-line DMT (HR 0.44; 95%CI: 0.32-0.62, p < 0.0001). Discussion: Switching to high-efficacy DMTs reduces the rates of subsequent MS relapse at the population level. Competing Interests: JM has received research support from the Research Manitoba, Multiple Sclerosis Scientific Research Foundation, Consortium of MS Centers and Manitoba Medical Service Foundation and for MS trials from Biogen Idec, Roche, SanofiAventis and honoraria from Biogen Idec, Roche, and EMD Serono. OE and RF has nothing to disclose. RM has received research funding from the Canadian Institutes of Health Research, Research Manitoba, Multiple Sclerosis Society of Canada, Multiple Sclerosis Scientific Research Foundation, Crohn’s and Colitis Canada, US Department of Defense, CMSC, and National Multiple Sclerosis Society. She is a co-investigator on studies funded by the Biogen Idec and Roche. She serves on the Editorial Boards of Neurology and Multiple Sclerosis Journal. (Copyright © 2023 Marriott, Ekuma, Fransoo and Marrie.) |
| Databáze: | MEDLINE |
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