TY - JOUR
T1 - Evaluation of drivers of treatment switch in relapsing multiple sclerosis
T2 - a study from the Italian MS Registry
AU - the Italian MS Register
AU - Iaffaldano, Pietro
AU - Lucisano, Giuseppe
AU - Guerra, Tommaso
AU - Patti, Francesco
AU - Cocco, Eleonora
AU - De Luca, Giovanna
AU - Brescia Morra, Vincenzo
AU - Pozzilli, Carlo
AU - Zaffaroni, Mauro
AU - Ferraro, Diana
AU - Gasperini, Claudio
AU - Salemi, Giuseppe
AU - Bergamaschi, Roberto
AU - Lus, Giacomo
AU - Inglese, Matilde
AU - Romano, Silvia
AU - Bellantonio, Paolo
AU - Di Monte, Elisabetta
AU - Maniscalco, Giorgia Teresa
AU - Conte, Antonella
AU - Lugaresi, Alessandra
AU - Vianello, Marika
AU - Torri Clerici, Valentina Liliana Adriana
AU - Di Sapio, Alessia
AU - Pesci, Ilaria
AU - Granella, Franco
AU - Totaro, Rocco
AU - Marfia, Girolama Alessandra
AU - Danni, Maura Chiara
AU - Cavalla, Paola
AU - Valentino, Paola
AU - Aguglia, Umberto
AU - Montepietra, Sara
AU - Ferraro, Elisabetta
AU - Protti, Alessandra
AU - Spitaleri, Daniele
AU - Avolio, Carlo
AU - De Riz, Milena
AU - Maimone, Davide
AU - Cavaletti, Guido
AU - Gazzola, Paola
AU - Tedeschi, Gioacchino
AU - Sessa, Maria
AU - Rovaris, Marco
AU - Di Palma, Franco
AU - Gatto, Maurizia
AU - Cargnelutti, Daniela
AU - De Robertis̄, Francesca
AU - Logullo, Francesco Ottavio
AU - Rini, Augusto
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023.
PY - 2024/3
Y1 - 2024/3
N2 - 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.
AB - 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.
KW - Disease activity
KW - Disease-modifying therapies
KW - Multiple sclerosis
KW - Treatment switch
UR - http://www.scopus.com/inward/record.url?scp=85180433445&partnerID=8YFLogxK
U2 - 10.1007/s00415-023-12137-8
DO - 10.1007/s00415-023-12137-8
M3 - Article
AN - SCOPUS:85180433445
SN - 0340-5354
VL - 271
SP - 1150
EP - 1159
JO - Journal of Neurology
JF - Journal of Neurology
IS - 3
ER -