Variability of the response to immunotherapy among subgroups of patients with multiple sclerosis
Por:
Diouf, I, Malpas, CB, Sharmin, S, Roos, I, Horakova, D, Havrdova, EK, Patti, F, Shaygannejad, V, Ozakbas, S, Izquierdo, G, Eichau, S, Onofrj, M, Lugaresi, A, Alroughani, R, Prat, A, Girard, M, Duquette, P, Terzi, M, Boz, C, Grand'Maison, F, Hamdy, S, Sola, P, Ferraro, D, Grammond, P, Turkoglu, R, Buzzard, K, Skibina, O, Yamout, B, Altintas, A, Gerlach, O, van Pesch, V, Blanco, Y, Maimone, D, Lechner-Scott, J, Bergamaschi, R, Karabudak, R, Iuliano, G, McGuigan, C, Cartechini, E, Barnett, M, Hughes, S, Sa, MJ, Solaro, C, Kappos, L, Ramo-Tello, C, Cristiano, E, Hodgkinson, S, Spitaleri, D, Soysal, A, Petersen, T, Slee, M, Butler, E, Granella, F, de Gans, K, McCombe, P, Ampapa, R, Van Wijmeersch, B, van der Walt, A, Butzkueven, H, Prevost, J, Sinnige, LGF, Sanchez-Menoyo, JL, Vucic, S, Laureys, G, Van Hijfte, L, Khurana, D, Macdonell, R, Gouider, R, Castillo-Triviño, T, Gray, O, Aguera-Morales, E, Al-Asmi, A, Shaw, C, Deri, N, Al-Harbi, T, Fragoso, Y, Csepany, T, Sempere, AP, Trevino-Frenk, I, Schepel, J, Moore, F and Kalincik, T
Publicada:
1 abr 2023
Resumen:
Background and purpose: This study assessed the effect of patient characteristics on the response to disease-modifying therapy (DMT) in multiple sclerosis (MS).Methods: We extracted data from 61,810 patients from 135 centers across 35 countries from the MSBase registry. The selection criteria were: clinically isolated syndrome or definite MS, follow -up >= 1 year, and Expanded Disability Status Scale (EDSS) score >= 3, with >= 1 score recorded per year. Marginal structural models with interaction terms were used to compare the hazards of 12 -month confirmed worsening and improvement of disability, and the incidence of relapses between treated and untreated patients stratified by their characteristics.Results: Among 24,344 patients with relapsing MS, those on DMTs experienced 48% reduction in relapse incidence (hazard ratio [HR] = 0.52, 95% confidence interval [CI] = 0.45- 0.60), 46% lower risk of disability worsening (HR = 0.54, 95% CI = 0.41- 0.71), and 32% greater chance of disability improvement (HR = 1.32, 95% CI = 1.09- 1.59). The effect of DMTs on EDSS worsening and improvement and the risk of relapses was attenuated with more severe disability. The magnitude of the effect of DMT on suppressing relapses declined with higher prior relapse rate and prior cerebral magnetic resonance imaging activity. We did not find any evidence for the effect of age on the effectiveness of DMT. After inclusion of 1985 participants with progressive MS, the effect of DMT on disability mostly depended on MS phenotype, whereas its effect on relapses was driven mainly by prior relapse activity.Conclusions: DMT is generally most effective among patients with lower disability and in relapsing MS phenotypes. There is no evidence of attenuation of the effect of DMT with age.
Filiaciones:
Diouf, I:
Univ Melbourne, Dept Med, CORe, Melbourne, Vic, Australia
Malpas, CB:
Univ Melbourne, Dept Med, CORe, Melbourne, Vic, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Sharmin, S:
Univ Melbourne, Dept Med, CORe, Melbourne, Vic, Australia
Roos, I:
Univ Melbourne, Dept Med, CORe, Melbourne, Vic, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Horakova, D:
Charles Univ Prague, Fac Med 1, Dept Neurol, Prague, Czech Republic
Charles Univ Prague, Fac Med 1, Ctr Clin Neurosci, Prague, Czech Republic
Gen Univ Hosp, Prague, Czech Republic
Havrdova, EK:
Charles Univ Prague, Fac Med 1, Dept Neurol, Prague, Czech Republic
Charles Univ Prague, Fac Med 1, Ctr Clin Neurosci, Prague, Czech Republic
Gen Univ Hosp, Prague, Czech Republic
Patti, F:
GF Ingrassia, Dept Med & Surg Sci & Adv Technol, Catania, Italy
Shaygannejad, V:
Isfahan Univ Med Sci, Esfahan, Iran
Ozakbas, S:
Dokuz Eylul Univ, Konak Izmir, Turkiye
Izquierdo, G:
Hosp Univ Virgen Macarena, Seville, Spain
Eichau, S:
Hosp Univ Virgen Macarena, Seville, Spain
Onofrj, M:
DAnnunzio Univ, Dept Neurosci Imaging & Clin Sci, Chieti, Italy
Lugaresi, A:
IRCCS Ist Sci Neurol Bologna, Bologna, Italy
Univ Bologna, Dipartimento Sci Biomed & Neuromotorie, Bologna, Italy
Alroughani, R:
Amiri Hosp, Dept Med, Div Neurol, Sharq, Kuwait
Prat, A:
CHUM Mississippi Ctr, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Girard, M:
CHUM Mississippi Ctr, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Duquette, P:
CHUM Mississippi Ctr, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Terzi, M:
Ondokuz Mayis Univ, Sch Med, Samsun, Turkiye
Boz, C:
Farabi Hosp, KTU Med Fac, Trabzon, Turkiye
Grand'Maison, F:
Neuro Rive Sud, Quebec City, PQ, Canada
Hamdy, S:
Kasr Al Ainy MS Res Unit, Neurol, Cairo, Egypt
Sola, P:
Azienda Osped Univ, Dept Neurosci, Modena, Italy
Ferraro, D:
Azienda Osped Univ, Dept Neurosci, Modena, Italy
Grammond, P:
CISSS Chaudiere Appalache, St Marie, PQ, Canada
Turkoglu, R:
Haydarpasa Numune Training & Res Hosp, Istanbul, Turkiye
Buzzard, K:
Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia
Skibina, O:
Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia
Yamout, B:
Amer Univ Beirut, Nehme & Therese Tohme Multiple Sclerosis Ctr, Med Ctr, Beirut, Lebanon
Altintas, A:
Koc Univ, Sch Med, Dept Neurol, Istanbul, Turkiye
Koc Univ, Res Ctr Translat Med, Istanbul, Turkiye
Gerlach, O:
Zuyderland Med Ctr, Sittard Geleen, Netherlands
van Pesch, V:
Clin Univ St Luc, Brussels, Belgium
Blanco, Y:
Hosp Clin Barcelona, Ctr Neuroimmunol, Serv Neurol, Barcelona, Spain
Maimone, D:
Garibaldi Hosp, Catania, Italy
Lechner-Scott, J:
Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia
Bergamaschi, R:
IRCCS Mondino Fdn, Pavia, Italy
Karabudak, R:
Hacettepe Univ, Ankara, Turkiye
Iuliano, G:
Osped Riuniti Salerno, Salerno, Italy
McGuigan, C:
St Vincents Univ Hosp, Dublin, Ireland
Cartechini, E:
Azienda Sanit Unica Reg Marche AV3, UOC Neurol, Macerata, Italy
Barnett, M:
Brain & Mind Ctr, Sydney, NSW, Australia
Hughes, S:
Royal Victoria Hosp, Belfast, Antrim, North Ireland
Sa, MJ:
Ctr Hosp Univ Sao Joao, Dept Neurol, Porto, Portugal
Solaro, C:
ASL3 Genovese, Dept Neurol, Genoa, Italy
ML Novarese Hosp Moncrivello, Dept Rehabil, Genoa, Italy
Kappos, L:
Univ Hosp, Dept Med, Neurol Clin & Policlin, Basel, Switzerland
Univ Hosp, Dept Clin Res, Neurol Clin & Policlin, Basel, Switzerland
Univ Basel, Basel, Switzerland
:
Trias & Pujol Bros Univ Hosp, Badalona, Spain
Cristiano, E:
Hosp Italiano Buenos Aires, Buenos Aires, DF, Argentina
Hodgkinson, S:
Liverpool Hosp, Sydney, NSW, Australia
Spitaleri, D:
Azienda Osped Rilievo Nazl San Giuseppe Moscati A, Avellino, Italy
Soysal, A:
Bakirkoy Educ & Res Hosp Psychiat & Neurol Dis, Istanbul, Turkiye
Petersen, T:
Aarhus Univ Hosp, Aarhus, Denmark
Slee, M:
Flinders Univ S Australia, Adelaide, SA, Australia
Butler, E:
Monash Med Ctr, Melbourne, Vic, Australia
Granella, F:
Univ Parma, Dept Med & Surg, Parma, Italy
de Gans, K:
Groene Hart Ziekenhuis, Gouda, Netherlands
McCombe, P:
Univ Queensland, Brisbane, Qld, Australia
Ampapa, R:
Nemocnice Jihlava, Jihlava, Czech Republic
Van Wijmeersch, B:
Rehabil & MS Ctr Overpelt, Hasselt, Belgium
Hasselt Univ, Hasselt, Belgium
van der Walt, A:
Monash Univ, Cent Clin Sch, Melbourne, Vic, Australia
Alfred Hosp, Dept Neurol, Melbourne, Vic, Australia
Butzkueven, H:
Austin Hlth, Melbourne, Vic, Australia
Prevost, J:
CSSS St Jerome, St Jerome, PQ, Canada
Sinnige, LGF:
Med Ctr Leeuwarden, Leeuwarden, Netherlands
Sanchez-Menoyo, JL:
Hosp Galdakao Usansolo, Galdakao, Spain
Vucic, S:
Westmead Hosp, Sydney, NSW, Australia
Laureys, G:
Univ Hosp Ghent, Ghent, Belgium
Van Hijfte, L:
Univ Hosp Ghent, Ghent, Belgium
Khurana, D:
Postgrad Inst Med Educ & Res, Chandigarh, India
Macdonell, R:
Austin Hlth, Melbourne, Vic, Australia
Gouider, R:
Razi Hosp, Dept Neurol, Manouba, Tunisia
Castillo-Triviño, T:
Hosp Univ Donostia, Inst Invest Sanitaria Biodonostia, San Sebastian, Spain
Gray, O:
South East Trust, Belfast, Antrim, North Ireland
Aguera-Morales, E:
Univ Hosp Reina Sofia, Cordoba, Spain
Al-Asmi, A:
Sultan Qaboos Univ Hosp, Dept Med, Seeb, Oman
Shaw, C:
Univ Hosp Geelong, Geelong, Vic, Australia
Deri, N:
Hosp Fernandez, Buenos Aires, DF, Argentina
Al-Harbi, T:
King Fahad Specialist Hosp Dammam, Neurol Dept, Dammam, Saudi Arabia
Fragoso, Y:
Univ Metropolitana Santos, Santos, SP, Brazil
Csepany, T:
Univ Debrecen, Fac Med, Dept Neurol, Debrecen, Hungary
Sempere, AP:
Hosp Gen Univ Alicante, Alicante, Spain
Trevino-Frenk, I:
Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico
Schepel, J:
Waikato Hosp, Hamilton, New Zealand
Moore, F:
Jewish Gen Hosp, Montreal, PQ, Canada
Kalincik, T:
Univ Melbourne, Dept Med, CORe, Melbourne, Vic, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Green Published, hybrid
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