Background: Discontinuation of disease-modifying therapies (DMTs) for MS is common. MSBase, a large global observational registry, affords a unique opportunity to investigate predictors of ‘post-DMT’ relapses and confirmed disability progression (CDP) in a diverse group of patients exposed to different DMTs. Materials/methods: Main inclusion criteria: clinician-confirmed MS diagnosis (2010 McDonald criteria); age ≥ 18 at index DMT start; ≥12 months on index DMT prior to discontinuation; ≥24 months of follow-up post-discontinuation; did not restart DMT for ≥6 months. Predictors of time to first relapse and 3-month CDP were analyzed using Cox proportional hazards regression adjusted for age, gender, baseline EDSS, EDSS stability and relapse-free period for ≥1 year prior to discontinuation, calendar epoch, index DMT and reason for discontinuation. Results: 4842 patients (74.2% female) from 20 MSBase Centers met our inclusion criteria. 3556 (73%) discontinued one of IFNβ preparations, 849 (18%) - glatiramer acetate, 308 (6%) - natalizumab and 129 (3%) – fingolimod; other DMTs were excluded because too few records were available. Overall post-discontinuation annualized relapse rate (95% CI) was 0.224 (0.219, 0.229) and CDP rate was 8.23 (7.72, 8.76) per 100 person-years. Risk of post-DMT relapse was higher in younger patients, female patients, those with moderate disability and a relapse within 1 year of discontinuation. Hazard of CDP increased with increasing disability at baseline and disease progression within 3 years prior to stopping DMT. Of all the DMTs, only natalizumab was associated with increased risk of both post-DMT relapse and CDP. Conclusions: Knowledge of post-DMT relapse and disability progression rates and predictors of post-DMT disease activity allows for a more informed discussion of DMT discontinuation in those patients who are considering this option.
Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy / Kister, Ilya; Spelman, Tim; Patti, Francesco; Duquette, Pierre; Trojano, Maria; Izquierdo, Guillermo; Lugaresi, Alessandra; Grammond, Pierre; Sola, Patrizia; Ferraro, Diana; Grand'Maison, Francois; Alroughani, Raed; Terzi, Murat; Boz, Cavit; Hupperts, Raymond; Lechner-Scott, Jeannette; Kappos, Ludwig; Pucci, Eugenio; Hodgkinson, Suzanne; Solaro, Claudio; Butzkueven, Helmut. - In: JOURNAL OF THE NEUROLOGICAL SCIENCES. - ISSN 0022-510X. - 391(2018), pp. 72-76.
Data di pubblicazione: | 2018 |
Data di prima pubblicazione: | 2-giu-2018 |
Titolo: | Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy |
Autore/i: | Kister, Ilya; Spelman, Tim; Patti, Francesco; Duquette, Pierre; Trojano, Maria; Izquierdo, Guillermo; Lugaresi, Alessandra; Grammond, Pierre; Sola, Patrizia; Ferraro, Diana; Grand'Maison, Francois; Alroughani, Raed; Terzi, Murat; Boz, Cavit; Hupperts, Raymond; Lechner-Scott, Jeannette; Kappos, Ludwig; Pucci, Eugenio; Hodgkinson, Suzanne; Solaro, Claudio; Butzkueven, Helmut |
Autore/i UNIMORE: | |
Digital Object Identifier (DOI): | http://dx.doi.org/10.1016/j.jns.2018.06.001 |
Rivista: | |
Volume: | 391 |
Pagina iniziale: | 72 |
Pagina finale: | 76 |
Codice identificativo ISI: | WOS:000439672500016 |
Codice identificativo Scopus: | 2-s2.0-85048582568 |
Codice identificativo Pubmed: | 30103975 |
Citazione: | Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy / Kister, Ilya; Spelman, Tim; Patti, Francesco; Duquette, Pierre; Trojano, Maria; Izquierdo, Guillermo; Lugaresi, Alessandra; Grammond, Pierre; Sola, Patrizia; Ferraro, Diana; Grand'Maison, Francois; Alroughani, Raed; Terzi, Murat; Boz, Cavit; Hupperts, Raymond; Lechner-Scott, Jeannette; Kappos, Ludwig; Pucci, Eugenio; Hodgkinson, Suzanne; Solaro, Claudio; Butzkueven, Helmut. - In: JOURNAL OF THE NEUROLOGICAL SCIENCES. - ISSN 0022-510X. - 391(2018), pp. 72-76. |
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