Higher efficacy therapies appear to have a disproportionately larger effect in younger patients
ECTRIMS Online Library. Vollmer B. Sep 12, 2019; 279515; 237
Brandi Vollmer
Brandi Vollmer

Abstract: 237

Type: Free Communications

Abstract Category: Therapy - Long-term treatment monitoring

B. Vollmer1, K. Nair1,2, S. Sillau1, J. Corboy1, T. Vollmer1, E. Alvarez1

1Department of Neurology, 2Skagg's School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, United States

Introduction: Our previous studies demonstrated higher effectiveness with infusible DMTs (rituximab, natalizumab) when compared to oral disease modifying therapies (fingolimod, dimethyl fumarate) in the treatment of multiple sclerosis (MS). However, many patients do well on oral disease modifying therapies (DMTs). Identifying patients likely to experience disease activity in clinical practice is still a challenge.
Objective: To identify baseline characteristics associated with future disease activity in MS patients comparing oral and infusible DMTs.
Methods: Relapsing-remitting MS Patients prescribed fingolimod, dimethyl fumarate, natalizumab or rituximab at the Rocky Mountain MS Center at the University of Colorado were followed for 24 months or until drug discontinuation. Patients receiving oral (fingolimod, dimethyl fumarate) versus infusible (natalizumab, rituximab) were evaluated for disease activity, defined as experiencing a clinical relapse, new T2 lesion and/or gadolinium enhancing lesion (GdE).
Results: Of the 1004 patients analyzed, 509 received oral DMTs and 495 received infusible DMTs. In the oral DMT group, 36.4% experienced disease activity versus 21.2% in the infusible DMT group. Oral patients experiencing disease activity were younger (p< 0.001), had lower disease duration (p=0.010) and were more likely to have GdE on baseline MRI (p=0.015) than those who did not experience disease activity. Those < 45 years had greater odds of experiencing disease activity overall (OR=2.06, p< 0.001), clinical relapse (OR=2.20, p=0.008), new T2 lesion OR=2.95, p< 0.001), or GdE(OR=3.35, p< 0.001) compared to those ≥45 years. Infusible patients experiencing disease activity were younger (p=0.021) and were more likely to have GdE on baseline MRI (p=0.036). Those < 45 years had similar odds of experiencing disease activity overall (OR=1.35, p=0.232), clinical relapse (OR=1.16, p=0.726), new T2 lesion (OR=1.02, p=0.952), or GdE (OR=2.662, p=0.2013) compared to those ≥45 years. The unadjusted odds of experiencing disease activity with oral versus infusible DMTs is greater in younger patients (< 45 years:OR=2.67, p< 0.001) than older patients (≥45 years:OR=1.60, p=0.069).
Conclusions: Future disease activity is independently associated with younger patients and GdE lesions at baseline. Higher efficacy therapies appear to have a disproportionately larger effect on younger patients.
Disclosure: Brandi Vollmer has nothing to disclose. Kavita V Nair: has consulted and/or received research support from Astellas, Genentech,Novartis, and Biogen. Stefan Sillau has nothing to disclose. John Corboy: has received grant support from Novartis, Med Day, NMSS, and PCORI; sits on a steering committee for a clinical trial with Novartis; consults with Mylan on a legal issue; receives honorarium for speaking from the Rocky Mountain MS Center and PRIME CME, and receives compensation as editor of Neurology Clinical Practice.Timothy Vollmer: has received compensation for activities such as advisory boards, lectures and consultancy with the following companies and organizations: Academic CME; Alcimed; Anthem Blue Cross; Genentech/Roche; Biogen IDEC; Novartis; Celgene; EMD Serono; Epigene; Rocky Mountain MS Center; GLG Consulting; Ohio Health; TG Therapeutics; Topaz Therapeutics; Dleara Lawyers; and Teva Neuroscience; Biogen Australia & New Zealand; Sironax. He received research support from the following: Teva Neuroscience; NIH/NINDS; Rocky Mountain MS Center; Biogen; Actelion; Roche/Genentech; UT Southwestern; F. Hoffman-La Roche, Ltd and TG Therapeutics, Inc. Enrique Alvarez: has consulted for Biogen, Genzyme, Genentech, Teva, and Novartis; and received research funding from Rocky Mountain MS Center, Biogen, Novartis, Acorda, and Alkermes.

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