Details

Autor(en) / Beteiligte

• Lorscheider, Johannes
• Jokubaitis, Vilija G
• Spelman, Tim
• Izquierdo, Guillermo
• Lugaresi, Alessandra
• Havrdova, Eva
• Horakova, Dana
• Trojano, Maria
• Duquette, Pierre
• Girard, Marc
• Prat, Alexandre
• Grand'Maison, François
• Grammond, Pierre
• Pucci, Eugenio
• Boz, Cavit
• Sola, Patrizia
• Ferraro, Diana
• Spitaleri, Daniele
• Lechner-Scott, Jeanette
• Terzi, Murat
• Van Pesch, Vincent
• Iuliano, Gerardo
• Bergamaschi, Roberto
• Ramo-Tello, Cristina
• Granella, Franco
• Oreja-Guevara, Celia
• Butzkueven, Helmut
• Kalincik, Tomas

Titel

Anti-inflammatory disease-modifying treatment and short-term disability progression in SPMS

Ist Teil von

• Neurology, 2017-09, Vol.89 (10), p.1050-1059

Ort / Verlag

United States

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• To investigate the effect of disease-modifying treatment on short-term disability outcomes in secondary progressive multiple sclerosis (SPMS). Using MSBase, an international cohort study, we previously validated a highly accurate definition of SPMS. Here, we identified patients in MSBase who were either untreated or treated with a disease-modifying drug when meeting this definition. Propensity score matching was used to select subpopulations with comparable baseline characteristics. Disability outcomes were compared in paired, pairwise-censored analyses adjusted for treatment persistence, visit density, and relapse rates. Of the 2,381 included patients, 1,378 patients were matchable (treated n = 689, untreated n = 689). Median pairwise-censored follow-up was 2.1 years (quartiles 1.2-3.8 years). No difference in the risk of 6-month sustained disability progression was observed between the groups (hazard ratio [HR] 0.9, 95% confidence interval [CI] 0.7-1.1, = 0.27). We also did not find differences in any of the secondary endpoints: risk of reaching Expanded Disability Status Scale (EDSS) score ≥7 (HR 0.6, 95% CI 0.4-1.1, = 0.10), sustained disability reduction (HR 1.0, 95% CI 0.8-1.3, = 0.79), or change in disability burden (area under the EDSS-time curve, β = -0.05, = 0.09). Secondary and sensitivity analyses confirmed the results. Our pooled analysis of the currently available disease-modifying agents used after conversion to SPMS suggests that, on average, these therapies have no substantial effect on relapse-unrelated disability outcomes measured by the EDSS up to 4 years. This study provides Class IV evidence that for patients with SPMS, disease-modifying treatment has no beneficial effect on short-term disability progression.