- Title
- Disease Reactivation After Cessation of Disease-Modifying Therapy in Patients With Relapsing-Remitting Multiple Sclerosis
- Creator
- Roos, Izanne; Malpas, Charles; Eichau, Sara; Edan, Gilles; Prat, Alexandre; Girard, Marc; Ozakbas, Serkan; Grammond, Pierrre; Zephir, Helene; Ciron, Jonathan; Maillart, Elisabeth; Moreau, Thibault; Leray, Emmanuelle; Amato, MP; Labauge, P; Alroughani, R; Buzzard, K; Skibina, O; Terzi, M; Laplaud, DA; Berger, E; Grand'Maison, F; Lebrun-Frenay, C; Casey, Romain; Cartechini, E; Boz, C; Lechner-Scott, Jeanette; Clavelou, P; Stankoff, B; Prevost, J; Kappos, L; Pelletier, J; Shaygannejad, V; Yamout, B; Horakova, Dana; Khoury, SJ; Gerlach, O; Spitaleri, DLA; Van Pesch, V; Gout, O; Turkoglu, R; Heinzlef, O; Thouvenot, E; McCombe, PA; Soysal, A; Havrdova, Eva Kubala; Bourre, B; Slee, M; Castillo-Trivino, T; Bakchine, S; Ampapa, R; Butler, EG; Wahab, A; Macdonell, RA; Aguera-Morales, E; Cabre, P; Debouverie, Marc; Ben, NH; Van der Walt, A; Laureys, G; Van Hijfte, L; Ramo-Tello, CM; Maubeuge, N; Hodgkinson, S; Sanchez-Menoyo, JL; Barnett, MH; Labeyrie, C; Patti, Francesco; Vucic, S; Sidhom, Y; Gouider, R; Csepany, T; Sotoca, J; de Gans, K; Al-Asmi, A; Fragoso, YD; Vukusic, S; Butzkueven, H; De Seze, Jerome; Kalincik, T; Izquierdo, Guillermo
- Relation
- Neurogy Vol. 99, Issue 17, p. E1926-E1944
- Publisher Link
- http://dx.doi.org/10.1212/WNL.0000000000201029
- Publisher
- Wolters Kluwer Health
- Resource Type
- journal article
- Date
- 2022
- Description
- Background and Objectives: To evaluate the rate of return of disease activity after cessation of multiple sclerosis (MS) disease-modifying therapy. Methods: This was a retrospective cohort study from 2 large observational MS registries: MSBase and OFSEP. Patients with relapsing-remitting MS who had ceased a disease-modifying therapy and were followed up for the subsequent 12 months were included in the analysis. The primary study outcome was annualized relapse rate in the 12 months after disease-modifying therapy discontinuation stratified by patients who did, and did not, commence a subsequent therapy. The secondary endpoint was the predictors of first relapse and disability accumulation after treatment discontinuation. Results: A total of 14,213 patients, with 18,029 eligible treatment discontinuation epochs, were identified for 7 therapies. Annualized rates of relapse (ARRs) started to increase 2 months after natalizumab cessation (month 2-4 ARR 0.47, 95% CI 0.43–0.51). Commencement of a subsequent therapy within 2-4 months reduced the magnitude of disease reactivation (mean ARR difference: 0.15, 0.08–0.22). After discontinuation of fingolimod, rates of relapse increased overall (month 1–2 ARR: 0.80, 0.70–0.89) and stabilized faster in patients who started a new therapy within 1-2 months (mean ARR difference: 0.14, −0.01 to 0.29). The magnitude of disease reactivation for other therapies was low but reduced further by commencement of another treatment 1–10 months after treatment discontinuation. Predictors of relapse were a higher relapse rate in the year before cessation, female sex, younger age, and higher EDSS score. Commencement of a subsequent therapy reduced both the risk of relapse (HR 0.76, 95% CI 0.72–0.81) and disability accumulation (0.73, 0.65–0.80). Discussion: The rate of disease reactivation after treatment cessation differs among MS treatments, with the peaks of relapse activity ranging from 1 to 10 months in untreated cohorts that discontinued different therapies. These results suggest that untreated intervals should be minimized after stopping antitrafficking therapies (natalizumab and fingolimod).
- Subject
- multiple sclerosis; cohort analysis; disease duration; therapy effect; SDG 16; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1487779
- Identifier
- uon:52249
- Identifier
- ISSN:0028-3878
- Language
- eng
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