Publication: Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis.
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Identifiers
Date
2019
Authors
Brown, J William L
Coles, Alasdair
Horakova, Dana
Havrdova, Eva
Izquierdo, Guillermo
Prat, Alexandre
Girard, Marc
Duquette, Pierre
Trojano, Maria
Lugaresi, Alessandra
Advisors
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Volume Title
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Abstract
Within 2 decades of onset, 80% of untreated patients with relapsing-remitting multiple sclerosis (MS) convert to a phase of irreversible disability accrual termed secondary progressive MS. The association between disease-modifying treatments (DMTs), and this conversion has rarely been studied and never using a validated definition. To determine the association between the use, the type of, and the timing of DMTs with the risk of conversion to secondary progressive MS diagnosed with a validated definition. Cohort study with prospective data from 68 neurology centers in 21 countries examining patients with relapsing-remitting MS commencing DMTs (or clinical monitoring) between 1988-2012 with minimum 4 years' follow-up. The use, type, and timing of the following DMTs: interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab. After propensity-score matching, 1555 patients were included (last follow-up, February 14, 2017). Conversion to objectively defined secondary progressive MS. Of the 1555 patients, 1123 were female (mean baseline age, 35 years [SD, 10]). Patients initially treated with glatiramer acetate or interferon beta had a lower hazard of conversion to secondary progressive MS than matched untreated patients (HR, 0.71; 95% CI, 0.61-0.81; P Among patients with relapsing-remitting MS, initial treatment with fingolimod, alemtuzumab, or natalizumab was associated with a lower risk of conversion to secondary progressive MS vs initial treatment with glatiramer acetate or interferon beta. These findings, considered along with these therapies' risks, may help inform decisions about DMT selection.
Description
MeSH Terms
Adult
Alemtuzumab
Cohort Studies
Disease Progression
Female
Fingolimod Hydrochloride
Glatiramer Acetate
Humans
Immunologic Factors
Immunosuppressive Agents
Interferon-beta
Male
Multiple Sclerosis, Relapsing-Remitting
Natalizumab
Time-to-Treatment
Alemtuzumab
Cohort Studies
Disease Progression
Female
Fingolimod Hydrochloride
Glatiramer Acetate
Humans
Immunologic Factors
Immunosuppressive Agents
Interferon-beta
Male
Multiple Sclerosis, Relapsing-Remitting
Natalizumab
Time-to-Treatment