dc.contributor.author | Kister, Ilya | |
dc.contributor.author | Spelman, Tim | |
dc.contributor.author | Patti, Francesco | |
dc.contributor.author | Duquette, Pierre | |
dc.contributor.author | Trojano, Maria | |
dc.contributor.author | Izquierdo, Guillermo | |
dc.contributor.author | Butzkueven, Helmut | |
dc.date.accessioned | 2020-06-21T13:07:28Z | |
dc.date.available | 2020-06-21T13:07:28Z | |
dc.date.issued | 2018 | |
dc.identifier.issn | 0022-510X | |
dc.identifier.issn | 1878-5883 | |
dc.identifier.uri | https://doi.org/10.1016/j.jns.2018.06.001 | |
dc.identifier.uri | https://hdl.handle.net/20.500.12712/11494 | |
dc.description | Lugaresi, 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/0000-0001-9204-3216 | en_US |
dc.description | WOS: 000439672500016 | en_US |
dc.description | PubMed: 30103975 | en_US |
dc.description.abstract | Background: 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.sponsorship | Bayer ScheringBayer AG; Biogen IdecBiogen; Merck SeronoMerck SeronoMerck & Company; Novartis Pharma; SanofiSanofi-Aventis | en_US |
dc.description.sponsorship | No 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.iso | eng | en_US |
dc.publisher | Elsevier Science Bv | en_US |
dc.relation.isversionof | 10.1016/j.jns.2018.06.001 | en_US |
dc.rights | info:eu-repo/semantics/closedAccess | en_US |
dc.subject | Multiple sclerosis | en_US |
dc.subject | Relapse | en_US |
dc.subject | Disability | en_US |
dc.subject | Disease modifying therapy | en_US |
dc.subject | Observational cohort study | en_US |
dc.title | Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy | en_US |
dc.type | article | en_US |
dc.contributor.department | OMÜ | en_US |
dc.identifier.volume | 391 | en_US |
dc.identifier.startpage | 72 | en_US |
dc.identifier.endpage | 76 | en_US |
dc.relation.journal | Journal of the Neurological Sciences | en_US |
dc.relation.publicationcategory | Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı | en_US |