%0 Journal Article
%A Lorscheider, Johannes
%A Jokubaitis, Vilija G
%A Spelman, Tim
%A Izquierdo, Guillermo
%A Lugaresi, Alessandra
%A Havrdova, Eva
%A Horakova, Dana
%A Trojano, Maria
%A Duquette, Pierre
%A Girard, Marc
%A Prat, Alexandre
%A Grand'Maison, François
%A Grammond, Pierre
%A Pucci, Eugenio
%A Boz, Cavit
%A Sola, Patrizia
%A Ferraro, Diana
%A Spitaleri, Daniele
%A Lechner-Scott, Jeanette
%A Terzi, Murat
%A Van Pesch, Vincent
%A Iuliano, Gerardo
%A Bergamaschi, Roberto
%A Ramo-Tello, Cristina
%A Granella, Franco
%A Oreja-Guevara, Celia
%A Butzkueven, Helmut
%A Kalincik, Tomas
%A MSBase Study Group
%T Anti-inflammatory disease-modifying treatment and short-term disability progression in SPMS.
%D 2017
%U http://hdl.handle.net/10668/11492
%X To investigate the effect of disease-modifying treatment on short-term disability outcomes in secondary progressive multiple sclerosis (SPMS). Using MSBase, an international cohort study, we previously validated a highly accurate definition of SPMS. Here, we identified patients in MSBase who were either untreated or treated with a disease-modifying drug when meeting this definition. Propensity score matching was used to select subpopulations with comparable baseline characteristics. Disability outcomes were compared in paired, pairwise-censored analyses adjusted for treatment persistence, visit density, and relapse rates. Of the 2,381 included patients, 1,378 patients were matchable (treated n = 689, untreated n = 689). Median pairwise-censored follow-up was 2.1 years (quartiles 1.2-3.8 years). No difference in the risk of 6-month sustained disability progression was observed between the groups (hazard ratio [HR] 0.9, 95% confidence interval [CI] 0.7-1.1, p = 0.27). We also did not find differences in any of the secondary endpoints: risk of reaching Expanded Disability Status Scale (EDSS) score ≥7 (HR 0.6, 95% CI 0.4-1.1, p = 0.10), sustained disability reduction (HR 1.0, 95% CI 0.8-1.3, p = 0.79), or change in disability burden (area under the EDSS-time curve, β = -0.05, p = 0.09). Secondary and sensitivity analyses confirmed the results. Our pooled analysis of the currently available disease-modifying agents used after conversion to SPMS suggests that, on average, these therapies have no substantial effect on relapse-unrelated disability outcomes measured by the EDSS up to 4 years. This study provides Class IV evidence that for patients with SPMS, disease-modifying treatment has no beneficial effect on short-term disability progression.
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