OBJECTIVE: To determine the effectiveness of high-efficacy disease-modifying therapies (heDMT) versus medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naïve patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry. METHODS: We identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity-score matched sample of patients starting meDMT. RESULTS: We included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval (CI): 10.4%-23.0%) and 30.1% (95% CI: 23.1%-37.1%) for heDMT- and meDMT-initiators, respectively (Hazard ratio (HR): 0.53, 95% CI 0.33-0.83, p=0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37-0.67). Results were similar after pairwise censoring and in subgroups with high-baseline activity, diagnosis after year 2006 or information on baseline T2 lesion load. CONCLUSION: We found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.
OBJECTIVE: To determine the effectiveness of high-efficacy disease-modifying therapies (heDMT) versus medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naïve patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry. METHODS: We identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity-score matched sample of patients starting meDMT. RESULTS: We included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval (CI): 10.4%-23.0%) and 30.1% (95% CI: 23.1%-37.1%) for heDMT- and meDMT-initiators, respectively (Hazard ratio (HR): 0.53, 95% CI 0.33-0.83, p=0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37-0.67). Results were similar after pairwise censoring and in subgroups with high-baseline activity, diagnosis after year 2006 or information on baseline T2 lesion load. CONCLUSION: We found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.
Authors: Nabil Seery; Sifat Sharmin; Vivien Li; Ai-Lan Nguyen; Claire Meaton; Roberts Atvars; Nicola Taylor; Kelsey Tunnell; John Carey; Mark P Marriott; Katherine A Buzzard; Izanne Roos; Chris Dwyer; Josephine Baker; Lisa Taylor; Kymble Spriggs; Trevor J Kilpatrick; Tomas Kalincik; Mastura Monif Journal: CNS Drugs Date: 2021-04-13 Impact factor: 5.749
Authors: Joke Temmerman; Floris Van Der Veken; Sebastiaan Engelborghs; Kaat Guldolf; Guy Nagels; Dirk Smeets; Gert-Jan Allemeersch; Lars Costers; Marie B D'hooghe; Anne-Marie Vanbinst; Jeroen Van Schependom; Maria Bjerke; Miguel D'haeseleer Journal: J Clin Med Date: 2022-01-20 Impact factor: 4.241
Authors: Enric Monreal; Susana Sainz de la Maza; Lucienne Costa-Frossard; Paulette Walo-Delgado; Javier Zamora; José Ignacio Fernández-Velasco; Noelia Villarrubia; Mercedes Espiño; Daniel Lourido; Paloma Lapuente; Inmaculada Toboso; José Carlos Álvarez-Cermeño; Jaime Masjuan; Luisa María Villar Journal: Neurol Neuroimmunol Neuroinflamm Date: 2021-07-22