Tim Spelman1, Thomas Frisell2, Fredrik Piehl3, Jan Hillert3. 1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia. 2. Department of Medicine, Karolinska Institutet, Solna, Sweden. 3. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVE: To compare treatment effectiveness and persistence in relapsing-remitting multiple sclerosis patients who initiated rituximab versus glatiramer acetate (GA) or interferon-beta (IFN-β). METHODS: A total of 461 patients from the Swedish MS registry in the rituximab arm were propensity score matched on a 1:2 basis with 922 patients from the IFN-β/GA comparator, between April 2005 and November 2015. Annualised relapse rate (ARR) was compared using the Poisson method. A marginal Cox model was used to analyse time to first relapse, 3-month confirmed disability progression and treatment discontinuation in the matched sample. A signed-rank test was used to compare Expanded Disability Status Scale (EDSS) change from baseline. RESULTS: Rituximab was associated with a reduction in ARR (0.003; 95% confidence interval (CI) = 0.001, 0.009) relative to IFN-β/GA (0.026; 95% CI = 0.020, 0.033) ( p < 0.001). Rituximab was associated with an 87% reduction in the relapse rate (hazard ratio (HR) = 0.13; 95% CI = 0.04, 0.41) and an 85% reduction in the discontinuation rate (HR = 0.15; 95% CI = 0.11, 0.20) relative to IFN-β/GA. EDSS regression from baseline was greater in the rituximab group at 12 and 24 months. CONCLUSION: Rituximab appears to be superior to first-generation disease-modifying treatments (DMTs) with respect to relapse control and tolerability, whereas superiority on disability outcomes is less clear.
OBJECTIVE: To compare treatment effectiveness and persistence in relapsing-remitting multiple sclerosispatients who initiated rituximab versus glatiramer acetate (GA) or interferon-beta (IFN-β). METHODS: A total of 461 patients from the Swedish MS registry in the rituximab arm were propensity score matched on a 1:2 basis with 922 patients from the IFN-β/GA comparator, between April 2005 and November 2015. Annualised relapse rate (ARR) was compared using the Poisson method. A marginal Cox model was used to analyse time to first relapse, 3-month confirmed disability progression and treatment discontinuation in the matched sample. A signed-rank test was used to compare Expanded Disability Status Scale (EDSS) change from baseline. RESULTS:Rituximab was associated with a reduction in ARR (0.003; 95% confidence interval (CI) = 0.001, 0.009) relative to IFN-β/GA (0.026; 95% CI = 0.020, 0.033) ( p < 0.001). Rituximab was associated with an 87% reduction in the relapse rate (hazard ratio (HR) = 0.13; 95% CI = 0.04, 0.41) and an 85% reduction in the discontinuation rate (HR = 0.15; 95% CI = 0.11, 0.20) relative to IFN-β/GA. EDSS regression from baseline was greater in the rituximab group at 12 and 24 months. CONCLUSION:Rituximab appears to be superior to first-generation disease-modifying treatments (DMTs) with respect to relapse control and tolerability, whereas superiority on disability outcomes is less clear.
Authors: Elisa Carolina Jácome Sánchez; María Ariana García Castillo; Victor Paredes González; Fernando Guillén López; Edgar Patricio Correa Díaz Journal: Mult Scler J Exp Transl Clin Date: 2018-04-08
Authors: Zhifeng Mao; César Álvarez-Gonzalez; Stefania De Trane; Ozlem Yildiz; Christo Albor; Gabriel Doctor; Derek Soon; George Pepper; Benjamin P Turner; Monica Marta; Joela Mathews; Gavin Giovannoni; David Baker; Klaus Schmierer Journal: Mult Scler J Exp Transl Clin Date: 2018-06-26