Effect of initial high-efficacy disease modifying therapy in relapsing-remitting multiple sclerosis: a nationwide cohort study
ECTRIMS Online Library. Buron M. Sep 12, 2019; 279335; P975
Mathias Due Buron
Mathias Due Buron
Contributions
Abstract

Abstract: P975

Type: Poster Sessions

Abstract Category: Therapy - Immunomodulation/Immunosuppression

M.D. Buron1,2, T.A. Chalmer1,2, I. Barzinji3, J.R. Christensen2, M.K.B. Christensen4, V. Hansen3, Z. Illes5, H.B. Jensen6,7, M. Kant8, T. Petersen4, P.V. Rasmussen4, J. Schäfer3, F. Sellebjerg2, Á. Theódórsdóttir5, A. Weglewski9, P.S. Sørensen2, M. Magyari1,2

1The Danish Multiple Sclerosis Registry, 2The Danish Multiple Sclerosis Center, Rigshospitalet, Copenhagen, 3Department of Neurology, Aalborg University Hospital, Aalborg, 4Department of Neurology, Aarhus University Hospital, Aarhus, 5Department of Neurology, Odense University Hospital, Odense, 6Brain and Nerve Diseases, Lillebaelt Hospital, Kolding, 7Institute of Regional Health Research, University of Southern Denmark, Odense, 8Department of Neurology, Hospital of Southern Jutland, Sønderborg, 9Department of Neurology, Herlev Hospital, Herlev, Denmark

Background: Patients with multiple sclerosis(MS) are often initially treated with moderately effective disease modifying therapies(meDMT), and in case of insufficient treatment response therapy is escalated to high efficacy disease modifying therapies(heDMT). For patients with perceived aggressive disease courses first-time treatment with heDMT is initiated. However, evidence on the impact of this strategy is scarce.
Objectives: To investigate any difference of disease activity in patients started initially on heDMT (natalizumab, fingolimod, ofatumumab, alemtuzumab, rituximab) compared to similar patients started on meDMT (teriflunomide, dimethyl fumarate, interferon-β, glatiramer gcetate).
Methods: Demographic and clinical information on patients initiating their first treatment from 2001 and onward was extracted from the nationwide population-based Danish Multiple Sclerosis Registry. We identified all patients initiating first-time treatment with heDMT and matched them to patients initiating first time treatment with meDMT using nearest neighbor propensity-score 1:1 greedy-matching with caliper. Variables used for matching were pre-treatment annual relapse rate, baseline EDSS, age, sex, and disease duration. Patients were observed from treatment start and until death, emigration or May 6th 2018, whichever came first.
We compared rates of 6-month confirmed EDSS worsening(CDW) and a first relapse using robust variance Cox-regression models with pairwise censoring.
As a subgroup, we only included patients with high baseline disease activity defined as ≥3 relapses within 24 months, or ≥2 relapses within 12 months.
Results: A total of 255 patients initiating first-time treatment with heDMT were available for matching, and 220 of these were successfully matched to 220 patients receiving meDMT. Mean follow-up was 44 months. During follow-up, treatment was escalated in 25% of patients in the meDMT group after a mean of 720 days. A total of 73 CDW occurred. Compared to the meDMT group the hazard ratio(HR) of CDW in the heDMT group was 0.62(95% Confidence Interval(CI) 0.39-1.00 p=0.049). The HR of a first relapse was 0.65(95%CI 0.45-0.94,p=0.022) for the heDMT versus the meDMT group. Estimates were similar in the subgroup with high baseline disease activity
Conclusions: Patients started initially on heDMT had a lower risk of EDSS worsening and a first relapse compared to patients started on meDMT. Results were similar in patients with high disease activity.
Disclosure: M. D. Buron has received support for congress participation from Roche.
T.A. Chalmer has received support for congress participation from Merck, Novartis, Biogen, and Roche.
F. Sellebjerg has served on scientific advisory boards, been on the steering committees of clinical trials, served as a consultant, received support for congress participation, received speaker honoraria, or received research support for his laboratory from Biogen, Merck, Novartis, Roche, Sanofi Genzyme and Teva.
Ismael Barzinji
M. K. B. Christensen: nothing to disclose.
Z. Illes has served on scientific advisory boards, served as a consultant, received support for congress participation, received speaker honoraria, and received research support from Biogen, Merck-Serono, Sanofi-Genzyme, Lundbeck, and Novartis.
A. Weglewski has served on scientific advisory board for Merck, received honoraria for lecturing from Sanofi Genzyme, has received support for congress participation from Biogen, Genzyme, Teva and Merck.
J Schäfer has received travel support for congress participation from Genzyme, Roche, Merck, Teva and Biogen.
P. S. Sørensen has received personal compensation for serving on scientific advisory boards, steering committees, independent data monitoring committees or have received speaker honoraria for Merck, Novartis, TEVA, GlaxoSmithKline, MedDay Pharmaceuticals, SanofiAventis/Genzyme, and Celgene.
H. B. Jensen: nothing to disclose.
P. V. Rasmussen has received speaker honoraria from TEVA, Biogen, Roche and Novartis, support for congress participation from Sanofi and TEVA, fees for serving on advisory boards from Roche, Novartis, Biogen and Sanofi.
Á. Theodorsdottir has served on a scientific advisory board, received support for congress participation, and received research support from Biogen, Roche and Novartis.
T. Petersen has received research grant support from Biogen, Merck, Novartis, Sanofi, Alexion, Roche and Genzyme.
M. Kant has received support for congress participation from Novartis, Genzyme, Teva and Roche.
I. Barzinji: nothing to disclose.
V. Hansen has received support for congress participation from Roche, Biogen, Merck, Sanofi Genzyme and Almirall.
J. R. Christenen reports non-financial support from Novartis.
M. Magyari has served on scientific advisory board for Biogen, Sanofi, Teva, Roche, Novartis, Merck, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, has received support for congress participation from Biogen, Genzyme, Teva, Roche

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