Viktor von Wyl1, Pascal Benkert2, André Moser3, Johannes Lorscheider4, Bernhard Décard4, Peter Hänni5, Carmen Lienert6, Jens Kuhle4, Tobias Derfuss4, Ludwig Kappos4, Özgür Yaldizli4. 1. Department of Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland/ Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland. 2. Clinical Trial Unit, University Hospital Basel, Basel, Switzerland. 3. Department of Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland. 4. Neurologic Clinic and Policlinic, Departments of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland. 5. Swiss Association for Joint Tasks of Health Insurers, Solothurn, Switzerland. 6. Department of Neurology, Rheinburg-Klinik, Walzenhausen, Switzerland.
Abstract
BACKGROUND: Disability progression independent of relapses (PIRA) has been described as a frequent phenomenon in relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE: To compare the occurrence of disability progression in relapse-free RRMS patients on interferon-beta/glatiramer acetate (IFN/GA) versus fingolimod. METHODS: This study is based on data from the Swiss association for joint tasks of health insurers. Time to relapse and 12-month confirmed disability progression were compared between treatment groups using multivariable Cox regression analysis with confounder adjustment. Inverse-probability weighting was applied to correct for the bias that patients on fingolimod have a higher chance to remain relapse-free than patients on IFN/GA. RESULTS: We included 1640 patients (64% IFN/GA, 36% fingolimod, median total follow-up time = 4-5 years). Disease-modifying treatment (DMT) groups were well balanced with regard to potential confounders. Disability progression was observed in 155 patients (8.8%) on IFN/GA and 51 (7.6%) on fingolimod, of which 44 and 23 were relapse-free during the initial DMT, respectively. Adjusted standard regression analysis on all patients indicated that those on fingolimod experience less frequently disability progression compared with IFN/GA (hazard ratio = 0.53 (95% confidence interval = 0.37-0.76)). After bias correction, this was also true for patients without relapses (hazard ratio=0.56 (95% confidence interval = 0.32-0.98). CONCLUSION: Our analysis indicates that fingolimod is superior to IFN/GA in preventing disability progression in both relapsing and relapse-free, young, newly diagnosed RRMS patients.
BACKGROUND: Disability progression independent of relapses (PIRA) has been described as a frequent phenomenon in relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE: To compare the occurrence of disability progression in relapse-free RRMS patients on interferon-beta/glatiramer acetate (IFN/GA) versus fingolimod. METHODS: This study is based on data from the Swiss association for joint tasks of health insurers. Time to relapse and 12-month confirmed disability progression were compared between treatment groups using multivariable Cox regression analysis with confounder adjustment. Inverse-probability weighting was applied to correct for the bias that patients on fingolimod have a higher chance to remain relapse-free than patients on IFN/GA. RESULTS: We included 1640 patients (64% IFN/GA, 36% fingolimod, median total follow-up time = 4-5 years). Disease-modifying treatment (DMT) groups were well balanced with regard to potential confounders. Disability progression was observed in 155 patients (8.8%) on IFN/GA and 51 (7.6%) on fingolimod, of which 44 and 23 were relapse-free during the initial DMT, respectively. Adjusted standard regression analysis on all patients indicated that those on fingolimod experience less frequently disability progression compared with IFN/GA (hazard ratio = 0.53 (95% confidence interval = 0.37-0.76)). After bias correction, this was also true for patients without relapses (hazard ratio=0.56 (95% confidence interval = 0.32-0.98). CONCLUSION: Our analysis indicates that fingolimod is superior to IFN/GA in preventing disability progression in both relapsing and relapse-free, young, newly diagnosed RRMS patients.
Authors: Gulfidan Bitirgen; Zehra Akpinar; Ali Ulvi Uca; Ahmet Ozkagnici; Ioannis N Petropoulos; Rayaz A Malik Journal: Transl Vis Sci Technol Date: 2020-12-21 Impact factor: 3.283