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The Capital Region of Denmark - a part of Copenhagen University Hospital
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Initial high-efficacy disease-modifying therapy in multiple sclerosis: A nationwide cohort study

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  1. Association Between EEG Patterns and Serum Neurofilament Light After Cardiac Arrest: A Post Hoc Analysis of the TTM Trial

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  2. Patient-Centered Treatment of Chronic Migraine With Medication Overuse: More Is Not Always Better

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  3. Lack of Association of Group A Streptococcal Infections and Onset of Tics: European Multicenter Tics in Children Study

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  4. Epilepsy-Related Mortality in Children and Young Adults in Denmark: A Nationwide Cohort Study

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  1. Ofatumumab Modulates Inflammatory T Cell Responses and Migratory Potential in Patients With Multiple Sclerosis

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  2. Pregnancy in women with MS: Impact on long-term disability accrual in a nationwide Danish Cohort

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  3. Antidrug Antibodies Against Biological Treatments for Multiple Sclerosis

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OBJECTIVE: To determine the effectiveness of high-efficacy disease-modifying therapies (heDMTs) vs medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naive patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry.

METHODS: We identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity score matched sample of patients starting meDMT.

RESULTS: We included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval [CI] 10.4%-23.0%) and 30.1% (95% CI 23.1%-37.1%) for heDMT and meDMT initiators, respectively (hazard ratio [HR] 0.53, 95% CI 0.33-0.83, p = 0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37-0.67). Results were similar after pairwise censoring and in subgroups with high baseline activity, diagnosis after 2006, or information on baseline T2 lesion load.

CONCLUSION: We found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.

Original languageEnglish
Article number32636328
JournalNeurology
Volume95
Issue number8
Pages (from-to)e1041-e1051
Number of pages11
ISSN0028-3878
DOIs
Publication statusPublished - 25 Aug 2020

    Research areas

  • Adult, Cohort Studies, Denmark, Female, Humans, Immunologic Factors/therapeutic use, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting/drug therapy, Treatment Outcome

ID: 61323617