Erschienen in:
22.12.2023 | Original Communication
Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry
verfasst von:
Pietro Iaffaldano, Giuseppe Lucisano, Tommaso Guerra, Francesco Patti, Eleonora Cocco, Giovanna De Luca, Vincenzo Brescia Morra, Carlo Pozzilli, Mauro Zaffaroni, Diana Ferraro, Claudio Gasperini, Giuseppe Salemi, Roberto Bergamaschi, Giacomo Lus, Matilde Inglese, Silvia Romano, Paolo Bellantonio, Elisabetta Di Monte, Giorgia Teresa Maniscalco, Antonella Conte, Alessandra Lugaresi, Marika Vianello, Valentina Liliana Adriana Torri Clerici, Alessia Di Sapio, Ilaria Pesci, Franco Granella, Rocco Totaro, Girolama Alessandra Marfia, Maura Chiara Danni, Paola Cavalla, Paola Valentino, Umberto Aguglia, Sara Montepietra, Elisabetta Ferraro, Alessandra Protti, Daniele Spitaleri, Carlo Avolio, Milena De Riz, Davide Maimone, Guido Cavaletti, Paola Gazzola, Gioacchino Tedeschi, Maria Sessa, Marco Rovaris, Franco Di Palma, Maurizia Gatto, Daniela Cargnelutti, Francesca De Robertis̄, Francesco Ottavio Logullo, Augusto Rini, Giuseppe Meucci, Bonaventura Ardito, Paola Banfi, Davide Nasuelli, Damiano Paolicelli, Maria Assunta Rocca, Emilio Portaccio, Clara Grazia Chisari, Giuseppe Fenu, Marco Onofrj, Antonio Carotenuto, Serena Ruggieri, Carla Tortorella, Paolo Ragonese, Mihaela Nica, Maria Pia Amato, Massimo Filippi, Maria Trojano, The Italian MS Register
Erschienen in:
Journal of Neurology
|
Ausgabe 3/2024
Einloggen, um Zugang zu erhalten
Abstract
Background
Active relapsing–remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as “relapsing MS” (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD).
Methods
RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT’s class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs].
Results
A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02–0.37), Natalizumab (0.48, 0.30–0.76), Ocrelizumab (0.1, 0.02–0.45) and Rituximab (0.23, 0.06–0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31–0.59), especially anti-CD20 drugs (0.14, 0.05–0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs.
Conclusions
More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.