TY - JOUR
T1 - Effects of High- and Low-Efficacy Therapy in Secondary Progressive Multiple Sclerosis
AU - Roos, Izanne
AU - Leray, Emmanuelle
AU - Casey, Romain
AU - Horakova, Dana
AU - Havrdova, Eva
AU - Izquierdo, Guillermo
AU - Madueño, Sara Eichau
AU - Patti, Francesco
AU - Edan, Gilles
AU - Debouverie, Marc
AU - Pelletier, Jean
AU - Ozakbas, Serkan
AU - Amato, Maria Pia
AU - Clavelou, Pierre
AU - Grammond, Pierre
AU - Boz, Cavit
AU - Buzzard, Katherine
AU - Skibina, Olga
AU - Ciron, Jonathan
AU - Gerlach, Oliver
AU - Grand'Maison, Francois
AU - Lechner-Scott, Jeannette
AU - Malpas, Charles
AU - Butzkueven, Helmut
AU - Vukusic, Sandra
AU - Kalincik, Tomas
AU - the MSBase and OFSEP Study Groups
N1 - Publisher Copyright:
© 2021 American Academy of Neurology.
Copyright:
This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
PY - 2021/8/31
Y1 - 2021/8/31
N2 - OBJECTIVE: To compare the clinical effectiveness of high- and low-efficacy treatments in patients with recently active and inactive secondary progressive multiple sclerosis (SPMS) after accounting for therapeutic lag. METHODS: Patients treated with high-efficacy (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) or low-efficacy (interferon beta, glatiramer acetate, teriflunomide) therapies after SPMS onset were selected from MSBase and Observatoire Français de la Sclérose en Plaques (OFSEP), 2 large observational cohorts. Therapeutic lag was estimated for each patient from their demographic and clinical characteristics. Propensity score was used to match patients treated with high- and low-efficacy therapies. Outcomes after the period of therapeutic lag was disregarded were compared in paired, pairwise-censored analyses. RESULTS: One thousand patients were included in the primary analysis. Patients with active SPMS treated with high-efficacy therapy experienced less frequent relapses than those on low-efficacy therapy (hazard ratio [HR] 0.7, p = 0.006). In patients with inactive SPMS, there was no evidence for a difference in relapse frequency between groups (HR 0.8, p = 0.39). No evidence for a difference in the risk of disability progression was observed. CONCLUSION: In treated patients with SPMS, high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active but not those with inactive SPMS. However, more potent therapies do not offer an advantage in reducing disability progression in this patient group. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active SPMS, although we did not find a difference in disability progression between patients treated with high- and low-efficacy therapy.
AB - OBJECTIVE: To compare the clinical effectiveness of high- and low-efficacy treatments in patients with recently active and inactive secondary progressive multiple sclerosis (SPMS) after accounting for therapeutic lag. METHODS: Patients treated with high-efficacy (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) or low-efficacy (interferon beta, glatiramer acetate, teriflunomide) therapies after SPMS onset were selected from MSBase and Observatoire Français de la Sclérose en Plaques (OFSEP), 2 large observational cohorts. Therapeutic lag was estimated for each patient from their demographic and clinical characteristics. Propensity score was used to match patients treated with high- and low-efficacy therapies. Outcomes after the period of therapeutic lag was disregarded were compared in paired, pairwise-censored analyses. RESULTS: One thousand patients were included in the primary analysis. Patients with active SPMS treated with high-efficacy therapy experienced less frequent relapses than those on low-efficacy therapy (hazard ratio [HR] 0.7, p = 0.006). In patients with inactive SPMS, there was no evidence for a difference in relapse frequency between groups (HR 0.8, p = 0.39). No evidence for a difference in the risk of disability progression was observed. CONCLUSION: In treated patients with SPMS, high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active but not those with inactive SPMS. However, more potent therapies do not offer an advantage in reducing disability progression in this patient group. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active SPMS, although we did not find a difference in disability progression between patients treated with high- and low-efficacy therapy.
UR - http://www.scopus.com/inward/record.url?scp=85115902390&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000012354
DO - 10.1212/WNL.0000000000012354
M3 - Article
C2 - 34193589
AN - SCOPUS:85115902390
VL - 97
SP - e869-e880
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 9
ER -