151. (DXT65) Longitudinal Disability Follow-up in Patients with 6-Month Confirmed Disability Improvement or Worsening in the CARE-MS and Extension Studies.
- Author
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Hunter, Samuel F., Baker, Darren P., Ozog, Mark, Poole, Elizabeth M., Chung, Luke, Vermersch, Patrick, Aburashed, Rany A., Alroughani, Raed, Dive, Dominique, Ho Jin Kim, Lycke, Jan, Macdonell, Richard A. L., Pozzilli, Carlo, and Wiendl, Heinz
- Subjects
CONFERENCES & conventions ,PATIENT aftercare ,MULTIPLE sclerosis ,PEOPLE with disabilities ,TIME - Abstract
Background: In the 2-year CARE-MS trials (trial registration: NCT00530348; NCT00548405), alemtuzumab (12 mg/day; baseline: 5 days; 12 months later: 3 days) significantly improved clinical/magnetic resonance imaging outcomes vs subcutaneous interferon beta-1a in patients with relapsing-remitting multiple sclerosis (RRMS). Efficacy in alemtuzumab-treated patients was maintained through year 9 in 2 consecutive extension studies (NCT00930553; NCT02255656 [TOPAZ]). Objectives: To evaluate the status of disability over 9 years in pooled CARE-MS patients who had either 6-month confirmed disability improvement (CDI) or 6-month confirmed disability worsening (CDW) by years 2 or 9. Methods: Alemtuzumab-treated CARE-MS patients with baseline Expanded Disability Status Scale (EDSS) score ≥2 were stratified into 3 subgroups: with CDI, with CDW, or with stable disability. CDI and CDW were defined as ≥1-point decrease and increase, respectively, in EDSS score from core study baseline confirmed over 6 months. Improved and stable EDSS scores each year were defined as ≥1-point decrease and ≤0.5-point change in either direction, respectively, from core study baseline in available patients. Results: 511/811 (63%) alemtuzumab-treated patients had baseline EDSS score ≥2. Of these, 222 (43%) patients had 365 unique CDI events and 172 (34%) patients had 217 CDW events at any time during the 9-year study; 31 (6%) had both CDI and CDW. Few patients (n = 12) had a CDW event after CDI. Of patients with CDI at any time over 9 years, mean EDSS score change was --0.58 at year 9 vs core study baseline, and 51% had lower EDSS scores at year 9. Similar EDSS outcomes were observed at year 9 in the subset of patients who achieved CDI within the first 2 years of the study. However, patients with CDW any time over 9 years had worsened disability at year 9, with a +1.71 mean change in EDSS score from core study baseline; patients with CDW in the first 2 years of the study had a +2.27 EDSS score change by year 9. EDSS scores remained stable at 9 years (mean change, --0.10) in the 148 (29%) patients who had neither CDI nor CDW. Compared with previous years, no new safety signals were identified in year 9 in CARE-MS extension study patients. Conclusions: Achievement of CDI at any point in the CARE-MS studies was associated with improved disability at year 9 vs baseline. However, those with CDW had increased disability over 9 years regardless of when worsening occurred. These findings suggest that both CDI and CDW are meaningful end points for predicting long-term disability outcomes in patients with RRMS. [ABSTRACT FROM AUTHOR]
- Published
- 2020