- Title
- Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy
- Creator
- Kister, Ilya; Spelman, Tim; Grand'Maison, Francois; Alroughani, Raed; Terzi, Murat; Boz, Cavit; Hupperts, Raymond; Lechner-Scott, Jeannette; Kappos, Ludwig; Pucci, Eugenio; Hodgkinson, Suzanne; Solaro, Claudio; Patti, Francesco; Butzkueven, Helmut; Duquette, Pierre; Trojano, Maria; Izquierdo, Guillermo; Lugaresi, Alessandra; Grammond, Pierre; Sola, Patrizia; Ferraro, Diana
- Relation
- Journal of the Neurological Sciences Vol. 391, Issue 15 August 2018, p. 72-76
- Publisher Link
- http://dx.doi.org/10.1016/j.jns.2018.06.001
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2018
- Description
- Background: Discontinuation of disease-modifying therapies (DMTs) for MS is common. MSBase, a large global observational registry, affords a unique opportunity to investigate predictors of ‘post-DMT’ relapses and confirmed disability progression (CDP) in a diverse group of patients exposed to different DMTs. Materials/methods: Main inclusion criteria: clinician-confirmed MS diagnosis (2010 McDonald criteria); age ≥ 18 at index DMT start; ≥12 months on index DMT prior to discontinuation; ≥24 months of follow-up post-discontinuation; did not restart DMT for ≥6 months. Predictors of time to first relapse and 3-month CDP were analyzed using Cox proportional hazards regression adjusted for age, gender, baseline EDSS, EDSS stability and relapse-free period for ≥1 year prior to discontinuation, calendar epoch, index DMT and reason for discontinuation. Results: 4842 patients (74.2% female) from 20 MSBase Centers met our inclusion criteria. 3556 (73%) discontinued one of IFNβ preparations, 849 (18%) - glatiramer acetate, 308 (6%) - natalizumab and 129 (3%) – fingolimod; other DMTs were excluded because too few records were available. Overall post-discontinuation annualized relapse rate (95% CI) was 0.224 (0.219, 0.229) and CDP rate was 8.23 (7.72, 8.76) per 100 person-years. Risk of post-DMT relapse was higher in younger patients, female patients, those with moderate disability and a relapse within 1 year of discontinuation. Hazard of CDP increased with increasing disability at baseline and disease progression within 3 years prior to stopping DMT. Of all the DMTs, only natalizumab was associated with increased risk of both post-DMT relapse and CDP. Conclusions: Knowledge of post-DMT relapse and disability progression rates and predictors of post-DMT disease activity allows for a more informed discussion of DMT discontinuation in those patients who are considering this option.
- Subject
- multiple sclerosis; relapse; disability; disease modifying therapy; observational cohort study
- Identifier
- http://hdl.handle.net/1959.13/1440850
- Identifier
- uon:41240
- Identifier
- ISSN:0022-510X
- Language
- eng
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