Switching to second line MS disease-modifying therapies is associated with decreased relapse rate

Frontiers in Neurology

Neurology

Randall Fransoo¹  Ruth Ann Marrie²  James John Marriott³  Okechukwu Ekuma⁴ 

[1] Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;Section of Neurology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada;

关键词: multiple sclerosis;    disease-modifying therapy;    treatment efficacy;    MS relapse;    MS epidemiology;   

DOI  :  10.3389/fneur.2023.1243589

 received in 2023-06-21, accepted in 2023-08-25,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background and objectivesWhile randomized, controlled trials (RCTs) are the gold standard for determining treatment efficacy, they do not capture the effectiveness of treatment during real-world use. We aimed to evaluate the association between demographics and multiple sclerosis (MS) disease-modifying therapy (DMT) exposure, including treatment adherence and switches between different DMTs, on the risk of subsequent MS relapse.MethodsAll persons with relapsing-onset MS (pwRMS) living in Manitoba between 1999 and 2014 were identified from provincial healthcare databases using a validated case definition. Use of DMTs was abstracted from the provincial drug database covering all residents of Manitoba, including use of any DMT, stopping/starting any DMT, switches between different DMTs and adherence as defined by cumulative medication possession ratios (CUMMPRs) of 50, 70, 80 and 90%. Time to first-treated relapse was used as the outcome of interest in logistic regression and Cox-proportional hazards regression models adjusting for demographic covariates including age and year of diagnosis, sex, socioeconomic status and number of medical comorbidities.Results1780 pwRMS were identified, including 1,510 who were on DMT at some point in the study period. While total DMT exposure was not associated with the time to subsequent treated relapse, individuals who switched between more than 2 DMTs had higher post-switch rates of relapse. Switching to second-line DMTs was associated with a longer time to treated relapse in comparison to those who remained on a first-line DMT (HR 0.44; 95%CI: 0.32–0.62, p < 0.0001).DiscussionSwitching to high-efficacy DMTs reduces the rates of subsequent MS relapse at the population level.

【 授权许可】

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Copyright © 2023 Marriott, Ekuma, Fransoo and Marrie.