OBJECTIVE: To evaluate whether an escalation approach was more effective in suppressing clinical and magnetic resonance imaging (MRI) activity than switching among immunomodulators in relapsing-remitting multiple sclerosis (RRMS) patients. METHODS: In this post-marketing, prospective, observational study in two Italian multiple sclerosis (MS) centres, a total of 285 RRMS patients who failed a first-line treatment withinterferon beta (IFNβ) or glatiramer acetate (GA) were considered. Patients were subdivided according to the strategy adopted after the failure (defined as the occurrence of ≥2 relapses or 1 relapse with residual disability): the switching (SWI) group, i.e. those switched among different IFNβ formulations, or from IFNβ to GA and vice versa; and the escalating (ESC) group, i.e. those escalated to natalizumab. Proportions of patients free from different types of disease activity (relapses, sustained disability progression, new active lesions on MRI, or a combination of them) were calculated at 12 and 24 months. Since patients were not randomized to treatment group, propensity score (PS)-adjusted Cox regression models were built to control for several potential confounders. RESULTS: At 12 months there were no differences between the two groups in proportions of patients free from relapse, disability progression, MRI activity, and combined activity. After 24 months we observed greater proportions of patients in the ESC than SWI group free from relapse (p < 0.0001), disability progression (p = 0.0045), MRI activity (p = 0.0003), and combined activity (p < 0.0001). PS-adjusted models confirmed these findings, with hazard ratios ranging from 0.38 to 0.56 favours the ESC group. CONCLUSION: We suggest that an escalation to natalizumab is more effective than switching among immunomodulators in RRMS patients who failed a first-line treatment.
RCT Entities:
OBJECTIVE: To evaluate whether an escalation approach was more effective in suppressing clinical and magnetic resonance imaging (MRI) activity than switching among immunomodulators in relapsing-remitting multiple sclerosis (RRMS) patients. METHODS: In this post-marketing, prospective, observational study in two Italian multiple sclerosis (MS) centres, a total of 285 RRMS patients who failed a first-line treatment with interferon beta (IFNβ) or glatiramer acetate (GA) were considered. Patients were subdivided according to the strategy adopted after the failure (defined as the occurrence of ≥2 relapses or 1 relapse with residual disability): the switching (SWI) group, i.e. those switched among different IFNβ formulations, or from IFNβ to GA and vice versa; and the escalating (ESC) group, i.e. those escalated to natalizumab. Proportions of patients free from different types of disease activity (relapses, sustained disability progression, new active lesions on MRI, or a combination of them) were calculated at 12 and 24 months. Since patients were not randomized to treatment group, propensity score (PS)-adjusted Cox regression models were built to control for several potential confounders. RESULTS: At 12 months there were no differences between the two groups in proportions of patients free from relapse, disability progression, MRI activity, and combined activity. After 24 months we observed greater proportions of patients in the ESC than SWI group free from relapse (p < 0.0001), disability progression (p = 0.0045), MRI activity (p = 0.0003), and combined activity (p < 0.0001). PS-adjusted models confirmed these findings, with hazard ratios ranging from 0.38 to 0.56 favours the ESC group. CONCLUSION: We suggest that an escalation to natalizumab is more effective than switching among immunomodulators in RRMS patients who failed a first-line treatment.
Authors: Tim Spelman; Tomas Kalincik; Vilija Jokubaitis; Annie Zhang; Fabio Pellegrini; Heinz Wiendl; Shibeshih Belachew; Robert Hyde; Freek Verheul; Alessandra Lugaresi; Eva Havrdová; Dana Horáková; Pierre Grammond; Pierre Duquette; Alexandre Prat; Gerardo Iuliano; Murat Terzi; Guillermo Izquierdo; Raymond M M Hupperts; Cavit Boz; Eugenio Pucci; Giorgio Giuliani; Patrizia Sola; Daniele L A Spitaleri; Jeannette Lechner-Scott; Roberto Bergamaschi; François Grand'Maison; Franco Granella; Ludwig Kappos; Maria Trojano; Helmut Butzkueven Journal: Neurol Clin Pract Date: 2016-04
Authors: R Lanzillo; S Bonavita; M Quarantelli; G Vacca; G Lus; L Amato; A Carotenuto; G Tedeschi; G Orefice; V Brescia Morra Journal: Neurol Sci Date: 2012-04-22 Impact factor: 3.307
Authors: Tomas Kalincik; Timothy Spelman; Maria Trojano; Pierre Duquette; Guillermo Izquierdo; Pierre Grammond; Alessandra Lugaresi; Raymond Hupperts; Edgardo Cristiano; Vincent Van Pesch; Francois Grand'maison; Daniele La Spitaleri; Maria Edite Rio; Sholmo Flechter; Celia Oreja-Guevara; Giorgio Giuliani; Aldo Savino; Maria Pia Amato; Thor Petersen; Ricardo Fernandez-Bolanos; Roberto Bergamaschi; Gerardo Iuliano; Cavit Boz; Jeannette Lechner-Scott; Norma Deri; Orla Gray; Freek Verheul; Marcela Fiol; Michael Barnett; Erik van Munster; Vetere Santiago; Fraser Moore; Mark Slee; Maria Laura Saladino; Raed Alroughani; Cameron Shaw; Krisztian Kasa; Tatjana Petkovska-Boskova; Leontien den Braber-Moerland; Joab Chapman; Eli Skromne; Joseph Herbert; Dieter Poehlau; Merrilee Needham; Elizabeth Alejandra Bacile Bacile; Walter Oleschko Arruda; Mark Paine; Bhim Singhal; Steve Vucic; Jose Antonio Cabrera-Gomez; Helmut Butzkueven Journal: PLoS One Date: 2013-05-21 Impact factor: 3.240