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dc.contributor.authorKister, Ilya
dc.contributor.authorSpelman, Tim
dc.contributor.authorPatti, Francesco
dc.contributor.authorDuquette, Pierre
dc.contributor.authorTrojano, Maria
dc.contributor.authorIzquierdo, Guillermo
dc.contributor.authorButzkueven, Helmut
dc.date.accessioned2020-06-21T13:07:28Z
dc.date.available2020-06-21T13:07:28Z
dc.date.issued2018
dc.identifier.issn0022-510X
dc.identifier.issn1878-5883
dc.identifier.urihttps://doi.org/10.1016/j.jns.2018.06.001
dc.identifier.urihttps://hdl.handle.net/20.500.12712/11494
dc.descriptionLugaresi, Alessandra/0000-0003-2902-5589; Ferraro, Diana/0000-0003-4818-3806; patti, francesco/0000-0002-6923-0846; Kister, Ilya/0000-0003-3549-949X; Spelman, Tim/0000-0001-9204-3216en_US
dc.descriptionWOS: 000439672500016en_US
dc.descriptionPubMed: 30103975en_US
dc.description.abstractBackground: Discontinuation of disease-modifying therapies (DMTs) for MS is common. MSBase, a large global observational registry, affords a unique opportunity to investigate predictors of 'post-DMT' relapses and confirmed disability progression (CDP) in a diverse group of patients exposed to different DMTs. Materials/methods: Main inclusion criteria: clinician-confirmed MS diagnosis (2010 McDonald criteria); age 18 at index DMT start; >= 12 months on index DMT prior to discontinuation; >= 24 months of follow-up post-discontinuation; did not restart DMT for >= 6 months. Predictors of time to first relapse and 3-month CDP were analyzed using Cox proportional hazards regression adjusted for age, gender, baseline EDSS, EDSS stability and relapse-free period for >= 1 year prior to discontinuation, calendar epoch, index DMT and reason for discontinuation. Results: 4842 patients (74.2% female) from 20 MSBase Centers met our inclusion criteria. 3556 (73%) discontinued one of IFN beta preparations, 849 (18%) - glatiramer acetate, 308 (6%) - natalizumab and 129 (3%) - fingolimod; other DMTs were excluded because too few records were available. Overall post-discontinuation annualized relapse rate (95% CI) was 0.224 (0.219, 0.229) and CDP rate was 8.23 (7.72, 8.76) per 100 person years. Risk of post-DMT relapse was higher in younger patients, female patients, those with moderate disability and a relapse within 1 year of discontinuation. Hazard of CDP increased with increasing disability at baseline and disease progression within 3 years prior to stopping DMT. Of all the DMTs, only natalizumab was associated with increased risk of both post-DMT relapse and CDP. Conclusions: Knowledge of post-DMT relapse and disability progression rates and predictors of post-DMT disease activity allows for a more informed discussion of DMT discontinuation in those patients who are considering this option.en_US
dc.description.sponsorshipBayer ScheringBayer AG; Biogen IdecBiogen; Merck SeronoMerck SeronoMerck & Company; Novartis Pharma; SanofiSanofi-Aventisen_US
dc.description.sponsorshipNo targeted funding was provided for this study. MSBase Foundation is a not-for-profit organization that receives support from Bayer Schering, Biogen Idec, Merck Serono, Novartis Pharma, and Sanofi.en_US
dc.language.isoengen_US
dc.publisherElsevier Science Bven_US
dc.relation.isversionof10.1016/j.jns.2018.06.001en_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectMultiple sclerosisen_US
dc.subjectRelapseen_US
dc.subjectDisabilityen_US
dc.subjectDisease modifying therapyen_US
dc.subjectObservational cohort studyen_US
dc.titlePredictors of relapse and disability progression in MS patients who discontinue disease-modifying therapyen_US
dc.typearticleen_US
dc.contributor.departmentOMÜen_US
dc.identifier.volume391en_US
dc.identifier.startpage72en_US
dc.identifier.endpage76en_US
dc.relation.journalJournal of the Neurological Sciencesen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US


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