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Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy

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Chalmer, Thor Ameri ; Kalincik, Tomas ; Laursen, Bjarne ; Sorensen, Per Soelberg ; Magyari, Melinda ; Members of Danish Multiple Sclerosis Group ; Frederiksen, Jette Lautrup Battistini ; Broksgaard Jensen, Michael ; Weglewski, Arkadiusz . / Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy. In: Journal of Neurology. 2019 ; Vol. 266, No. 2. pp. 306-315.

Bibtex

@article{529d54b5b8ba42b9b15729435e5f80ce,
title = "Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy",
abstract = "Background: Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT). Objective: To compare treatment effectiveness of switch to highly effective DMT (heDMT) with switch to moderately effective DMT (meDMT) for patients who switch due to disease breakthrough defined as at least one relapse within 12 months of their treatment switch. Methods: We retrieved data from The Danish Multiple Sclerosis Registry on all relapsing-remitting MS patients with expanded disability status scale (EDSS) less than 6 who experienced disease breakthrough. We used propensity score matching to compare annualized relapse rates (ARRs), time to first confirmed relapse, time to first confirmed EDSS worsening and time to first confirmed EDSS improvement. Results: Each matched group comprised 404 patients. Median follow-up time was 3.2 years [interquartile range (IQR) 1.7–5.8]. ARRs were 0.22 (0.19–0.27) with heDMT and 0.32 (IQR 0.28–0.37) with meDMT; relapse rate ratio was 0.70 (95{\%} CI 0.56–0.86; p = 0.001). Escalation to heDMT reduced the hazard of reaching a first relapse (HR 0.65; 95{\%} CI 0.53–0.80; p < 0.001). We found no evidence of delayed disability worsening (HR 0.83; 95{\%} CI 0.62–1.10; p = 0.20) and weak evidence of disability improvement (HR 1.33; 95{\%} CI 1.00–1.76; p = 0.05) with heDMT. Conclusion: Switching to heDMT is associated with reduced ARR and delay of first relapse compared with switching to meDMT. Patients on DMT who experience relapses should escalate therapy to heDMT.",
keywords = "Disease-modifying therapy, Multiple sclerosis, Observational comparison study, Treatment switch",
author = "Chalmer, {Thor Ameri} and Tomas Kalincik and Bjarne Laursen and Sorensen, {Per Soelberg} and Melinda Magyari and {Members of Danish Multiple Sclerosis Group} and Frederiksen, {Jette Lautrup Battistini} and {Broksgaard Jensen}, Michael and Arkadiusz Weglewski",
year = "2019",
month = "2",
day = "1",
doi = "10.1007/s00415-018-9126-y",
language = "English",
volume = "266",
pages = "306--315",
journal = "Journal of Neurology",
issn = "0340-5354",
publisher = "Dr. Dietrich/Steinkopff Verlag",
number = "2",

}

RIS

TY - JOUR

T1 - Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy

AU - Chalmer, Thor Ameri

AU - Kalincik, Tomas

AU - Laursen, Bjarne

AU - Sorensen, Per Soelberg

AU - Magyari, Melinda

AU - Members of Danish Multiple Sclerosis Group

A2 - Frederiksen, Jette Lautrup Battistini

A2 - Broksgaard Jensen, Michael

A2 - Weglewski, Arkadiusz

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT). Objective: To compare treatment effectiveness of switch to highly effective DMT (heDMT) with switch to moderately effective DMT (meDMT) for patients who switch due to disease breakthrough defined as at least one relapse within 12 months of their treatment switch. Methods: We retrieved data from The Danish Multiple Sclerosis Registry on all relapsing-remitting MS patients with expanded disability status scale (EDSS) less than 6 who experienced disease breakthrough. We used propensity score matching to compare annualized relapse rates (ARRs), time to first confirmed relapse, time to first confirmed EDSS worsening and time to first confirmed EDSS improvement. Results: Each matched group comprised 404 patients. Median follow-up time was 3.2 years [interquartile range (IQR) 1.7–5.8]. ARRs were 0.22 (0.19–0.27) with heDMT and 0.32 (IQR 0.28–0.37) with meDMT; relapse rate ratio was 0.70 (95% CI 0.56–0.86; p = 0.001). Escalation to heDMT reduced the hazard of reaching a first relapse (HR 0.65; 95% CI 0.53–0.80; p < 0.001). We found no evidence of delayed disability worsening (HR 0.83; 95% CI 0.62–1.10; p = 0.20) and weak evidence of disability improvement (HR 1.33; 95% CI 1.00–1.76; p = 0.05) with heDMT. Conclusion: Switching to heDMT is associated with reduced ARR and delay of first relapse compared with switching to meDMT. Patients on DMT who experience relapses should escalate therapy to heDMT.

AB - Background: Patients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT). Objective: To compare treatment effectiveness of switch to highly effective DMT (heDMT) with switch to moderately effective DMT (meDMT) for patients who switch due to disease breakthrough defined as at least one relapse within 12 months of their treatment switch. Methods: We retrieved data from The Danish Multiple Sclerosis Registry on all relapsing-remitting MS patients with expanded disability status scale (EDSS) less than 6 who experienced disease breakthrough. We used propensity score matching to compare annualized relapse rates (ARRs), time to first confirmed relapse, time to first confirmed EDSS worsening and time to first confirmed EDSS improvement. Results: Each matched group comprised 404 patients. Median follow-up time was 3.2 years [interquartile range (IQR) 1.7–5.8]. ARRs were 0.22 (0.19–0.27) with heDMT and 0.32 (IQR 0.28–0.37) with meDMT; relapse rate ratio was 0.70 (95% CI 0.56–0.86; p = 0.001). Escalation to heDMT reduced the hazard of reaching a first relapse (HR 0.65; 95% CI 0.53–0.80; p < 0.001). We found no evidence of delayed disability worsening (HR 0.83; 95% CI 0.62–1.10; p = 0.20) and weak evidence of disability improvement (HR 1.33; 95% CI 1.00–1.76; p = 0.05) with heDMT. Conclusion: Switching to heDMT is associated with reduced ARR and delay of first relapse compared with switching to meDMT. Patients on DMT who experience relapses should escalate therapy to heDMT.

KW - Disease-modifying therapy

KW - Multiple sclerosis

KW - Observational comparison study

KW - Treatment switch

U2 - 10.1007/s00415-018-9126-y

DO - 10.1007/s00415-018-9126-y

M3 - Journal article

VL - 266

SP - 306

EP - 315

JO - Journal of Neurology

JF - Journal of Neurology

SN - 0340-5354

IS - 2

ER -

ID: 56665638