Back to Search
Start Over
Effect of Disease-Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years
- Source :
- Neurology, Vol. 96, no. 5, p. e783-e797 (2021), Neurology, r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol, instname
- Publication Year :
- 2021
- Publisher :
- Lippincott Williams & Wilkins, 2021.
-
Abstract
- ObjectiveTo test the hypothesis that immunotherapy prevents long-term disability in relapsing-remitting multiple sclerosis (MS), we modeled disability outcomes in 14,717 patients.MethodsWe studied patients from MSBase followed for ≥1 year, with ≥3 visits, ≥1 visit per year, and exposed to MS therapy, and a subset of patients with ≥15-year follow-up. Marginal structural models were used to compare the cumulative hazards of 12-month confirmed increase and decrease in disability, Expanded Disability Status Scale (EDSS) step 6, and the incidence of relapses between treated and untreated periods. Marginal structural models were continuously readjusted for patient age, sex, pregnancy, date, disease course, time from first symptom, prior relapse history, disability, and MRI activity.ResultsA total of 14,717 patients were studied. During the treated periods, patients were less likely to experience relapses (hazard ratio 0.60, 95% confidence interval [CI] 0.43–0.82, p = 0.0016), worsening of disability (0.56, 0.38–0.82, p = 0.0026), and progress to EDSS step 6 (0.33, 0.19–0.59, p = 0.00019). Among 1,085 patients with ≥15-year follow-up, the treated patients were less likely to experience relapses (0.59, 0.50–0.70, p = 10−9) and worsening of disability (0.81, 0.67–0.99, p = 0.043).ConclusionContinued treatment with MS immunotherapies reduces disability accrual by 19%–44% (95% CI 1%–62%), the risk of need of a walking aid by 67% (95% CI 41%–81%), and the frequency of relapses by 40–41% (95% CI 18%–57%) over 15 years. This study provides evidence that disease-modifying therapies are effective in improving disability outcomes in relapsing-remitting MS over the long term.Classification of EvidenceThis study provides Class IV evidence that, for patients with relapsing-remitting MS, long-term exposure to immunotherapy prevents neurologic disability.
- Subjects :
- Adult
Male
medicine.medical_specialty
Article
03 medical and health sciences
Disability Evaluation
0302 clinical medicine
Natalizumab
Multiple Sclerosis, Relapsing-Remitting
multiple sclerosis, treatment, prognosis
Internal medicine
medicine
Humans
Immunologic Factors
Disease Progression
Female
Fingolimod Hydrochloride
Glatiramer Acetate
Immunosuppressive Agents
Interferon-beta
Longitudinal Studies
Middle Aged
Proportional Hazards Models
030212 general & internal medicine
Glatiramer acetate
Expanded Disability Status Scale
Proportional hazards model
business.industry
Multiple sclerosis
Hazard ratio
medicine.disease
Confidence interval
Cohort
Neurology (clinical)
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 00283878
- Database :
- OpenAIRE
- Journal :
- Neurology, Vol. 96, no. 5, p. e783-e797 (2021), Neurology, r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol, instname
- Accession number :
- edsair.doi.dedup.....a245873f8bac2f6b179793c2fa4ed9a0