Early rituximab versus escalating therapy in neuromyelitis optica: A cost and quality of life analysis.

Autor: Silva GD; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil. Electronic address: guilherme.diogo@hc.fm.usp.br., Apóstolos-Pereira SL; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil., Boaventura M; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil., Paolilo RB; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil; Neuroimmunology group, Instituto da Criança, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil., Matos A; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil., Pitombeira MS; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil; Neurology Service, Fortaleza General Hospital, Fortaleza, Brazil., Adoni T; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil., Sato DK; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil; Neurology Division, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil., Callegaro D; Neuroimmunology Group, Division of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Multiple sclerosis and related disorders [Mult Scler Relat Disord] 2024 Dec; Vol. 92, pp. 106160. Date of Electronic Publication: 2024 Nov 05.
DOI: 10.1016/j.msard.2024.106160
Abstrakt: Introduction: Rituximab, an anti-CD20 monoclonal antibody, has shown effectiveness in reducing disease relapses and disability accrual through relapses in patients with neuromyelitis optica spectrum disorders (NMOSD). However, its higher cost compared to oral immunosuppressants raises questions about its cost-effectiveness, particularly in low and middle-income countries. This study aimed to compare the cost-effectiveness of early rituximab treatment versus escalation treatment in NMOSD patients.
Methods: We conducted a retrospective study of NMOSD patients treated with rituximab in the first five years of disease at a hospital in São Paulo, Brazil, from 2015 to 2019. The Early Group consisted of NMOSD patients who received rituximab as a first-line treatment. The Escalating Therapy Group included patients who were prescribed rituximab after experiencing disease activity while on oral immunosuppressants, primarily azathioprine. An economic model based on Expanded Disability Status Score (EDSS) transitions was used to assess cost-effectiveness. Cost and utility data were derived from previous studies, and sensitivity analyses for different willingness to pay (WTP) thresholds and percentage of patients upscaling from oral immunossupressants to rituximab were performed.
Results: Thirty NMOSD patients were included. In the Early Group, the proportion of patients reaching the highest EDSS states (6.5 or more) decreased over five years compared to baseline. In contrast, the Escalating Therapy Group experienced an increase in this proportion over the same period. Cost-effectiveness was achieved for willingness to pay (WTP) of €20-80,000 in our main analysis, sustained in our sensitivity analysis.
Conclusion: Early treatment with rituximab has the potential to lower healthcare costs and enhance quality of life for NMOSD patients, supporting its early prescription for preventive treatment.
Competing Interests: Declaration of competing interest We authors declare conflict of interest due to regular visits and grants for research, events, or congress in the name of our institution with the following: - Biogen - Merck - Novartis - EMS - Roche - Horizon - Alexion / Astrazeneca
(Copyright © 2024. Published by Elsevier B.V.)
Databáze: MEDLINE
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