期刊
NEUROLOGY
卷 97, 期 9, 页码 E869-E880出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0000000000012354
关键词
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资金
- EDMUS Foundation
- National Health and Medical Research Council [1140766, 1129189, 1157717]
- MSIF-ARSEP McDonald fellowship grant
- Melbourne Research Scholarship
- Biogen
- Novartis
- Merck
- Roche
- Teva
- Sanofi Genzyme
- French State
- Agence Nationale de la Recherche [ANR-10-COHO-002]
- Eugene Devic EDMUS Foundation
- ARSEP Foundation
- National Health and Medical Research Council of Australia [1129189, 1157717] Funding Source: NHMRC
The study found that high-efficacy therapy is more effective in reducing relapse frequency in patients with active SPMS compared to low-efficacy therapy, but no significant difference was observed in patients with inactive SPMS. There was also no difference in disability progression between the two groups of patients.
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 Francais de la Sclerose 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.
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