RT Journal Article
T1 Disease Reactivation After Cessation of Disease-Modifying Therapy in Patients With Relapsing-Remitting Multiple Sclerosis.
A1 Roos, Izanne
A1 Malpas, Charles
A1 Leray, Emmanuelle
A1 Casey, Romain
A1 Horakova, Dana
A1 Havrdova, Eva Kubala
A1 Debouverie, Marc
A1 Patti, Francesco
A1 De Seze, Jerome
A1 Izquierdo, Guillermo
A1 Eichau, Sara
A1 Edan, Gilles
A1 Prat, Alexandre
A1 Girard, Marc
A1 Ozakbas, Serkan
A1 Grammond, Pierre
A1 Zephir, Helene
A1 Ciron, Jonathan
A1 Maillart, Elisabeth
A1 Moreau, Thibault
A1 Amato, Maria Pia
A1 Labauge, Pierre
A1 Alroughani, Raed
A1 Buzzard, Katherine
A1 Skibina, Olga
A1 Terzi, Murat
A1 Laplaud, David Axel
A1 Berger, Eric
A1 Grand'Maison, Francois
A1 Lebrun-Frenay, Christine
A1 Cartechini, Elisabetta
A1 Boz, Cavit
A1 Lechner-Scott, Jeannette
A1 Clavelou, Pierre
A1 Stankoff, Bruno
A1 Prevost, Julie
A1 Kappos, Ludwig
A1 Pelletier, Jean
A1 Shaygannejad, Vahid
A1 Yamout, Bassem I
A1 Khoury, Samia J
A1 Gerlach, Oliver
A1 Spitaleri, Daniele L A
A1 Van Pesch, Vincent
A1 Gout, Olivier
A1 Turkoglu, Recai
A1 Heinzlef, Olivier
A1 Thouvenot, Eric
A1 McCombe, Pamela Ann
A1 Soysal, Aysun
A1 Bourre, Bertrand
A1 Slee, Mark
A1 Castillo-Trivino, Tamara
A1 Bakchine, Serge
A1 Ampapa, Radek
A1 Butler, Ernest Gerard
A1 Wahab, Abir
A1 Macdonell, Richard A
A1 Aguera-Morales, Eduardo
A1 Cabre, Philippe
A1 Ben, Nasr Haifa
A1 Van der Walt, Anneke
A1 Laureys, Guy
A1 Van Hijfte, Liesbeth
A1 Ramo-Tello, Cristina M
A1 Maubeuge, Nicolas
A1 Hodgkinson, Suzanne
A1 Sánchez-Menoyo, José Luis
A1 Barnett, Michael H
A1 Labeyrie, Celine
A1 Vucic, Steve
A1 Sidhom, Youssef
A1 Gouider, Riadh
A1 Csepany, Tunde
A1 Sotoca, Javier
A1 de Gans, Koen
A1 Al-Asmi, Abdullah
A1 Fragoso, Yara Dadalti
A1 Vukusic, Sandra
A1 Butzkueven, Helmut
A1 Kalincik, Tomas
A1 MSBase and OFSEP, 
AB To evaluate the rate of return of disease activity after cessation of multiple sclerosis (MS) disease-modifying therapy. This was a retrospective cohort study from 2 large observational MS registries: MSBase and OFSEP. Patients with relapsing-remitting MS who had ceased a disease-modifying therapy and were followed up for the subsequent 12 months were included in the analysis. The primary study outcome was annualized relapse rate in the 12 months after disease-modifying therapy discontinuation stratified by patients who did, and did not, commence a subsequent therapy. The secondary endpoint was the predictors of first relapse and disability accumulation after treatment discontinuation. A total of 14,213 patients, with 18,029 eligible treatment discontinuation epochs, were identified for 7 therapies. Annualized rates of relapse (ARRs) started to increase 2 months after natalizumab cessation (month 2-4 ARR 0.47, 95% CI 0.43-0.51). Commencement of a subsequent therapy within 2-4 months reduced the magnitude of disease reactivation (mean ARR difference: 0.15, 0.08-0.22). After discontinuation of fingolimod, rates of relapse increased overall (month 1-2 ARR: 0.80, 0.70-0.89) and stabilized faster in patients who started a new therapy within 1-2 months (mean ARR difference: 0.14, -0.01 to 0.29). The magnitude of disease reactivation for other therapies was low but reduced further by commencement of another treatment 1-10 months after treatment discontinuation. Predictors of relapse were a higher relapse rate in the year before cessation, female sex, younger age, and higher EDSS score. Commencement of a subsequent therapy reduced both the risk of relapse (HR 0.76, 95% CI 0.72-0.81) and disability accumulation (0.73, 0.65-0.80). The rate of disease reactivation after treatment cessation differs among MS treatments, with the peaks of relapse activity ranging from 1 to 10 months in untreated cohorts that discontinued different therapies. These results suggest that untreated intervals should be minimized after stopping antitrafficking therapies (natalizumab and fingolimod). This study provides Class III that disease reactivation occurs within months of discontinuation of MS disease-modifying therapies. The risk of disease activity is reduced by commencement of a subsequent therapy.
YR 2022
FD 2022-08-17
LK http://hdl.handle.net/10668/20407
UL http://hdl.handle.net/10668/20407
LA en
DS RISalud
RD Apr 10, 2025