Effects of High and Low Efficacy Therapy in Secondary Progressive Multiple Sclerosis
2 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
3 CIC - Centre d'Investigation Clinique [Rennes]
4 EHESP - École des Hautes Études en Santé Publique
5 METIS - Département Méthodes quantitatives en santé publique
6 UCBL - Université Claude Bernard Lyon 1
7 1. LF UK / 1st Faculty of Medicine - 1. lékařská fakulta, Univerzita Karlova [Praha, Česká republika] = First Faculty of Medicine, Charles University [Prague, Czech Republic]
8 HUVM - Hospital Universitario Virgen Macarena [Séville]
9 Unict - Università degli studi di Catania = University of Catania
10 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
11 APEMAC - Adaptation, mesure et évaluation en santé. Approches interdisciplinaires
12 TIMONE - Hôpital de la Timone [CHU - APHM]
13 DEÜ - Dokuz Eylül Üniversitesi = Dokuz Eylül University [Izmir]
14 UniFI - Università degli Studi di Firenze = University of Florence = Université de Florence
15 CHU Clermont-Ferrand
16 CISSS Chaudières Appalaches, Hyperbaric Medicine Unit, Emergency Department
17 KTU Medical Faculty Farabi Hospital
18 The Royal Melbourne Hospital
19 Monash University [Melbourne]
20 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
21 Zuyderland Hospital [Heerlen, The Netherlands]
22 Neuro Rive-Sud
23 UoN - University of Newcastle [Callaghan, Australia]
- Fonction : Auteur
- PersonId : 18386
- IdHAL : emmanuelle-leray
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- ORCID : 0000-0001-9730-7567
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- ORCID : 0000-0002-3386-6308
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- Fonction : Auteur
- PersonId : 740274
- IdHAL : adil-maarouf
- ORCID : 0000-0002-6755-496X
- IdRef : 164833250
Résumé
OBJECTIVE: To compare the clinical effectiveness of high- and low-efficacy treatments in patients with recently active and inactive secondary progressive multiple sclerosis (SPMS) after accounting for therapeutic lag. METHODS: Patients treated with high- (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) or low-efficacy (interferon β, glatiramer acetate, teriflunomide) therapies after SPMS onset were selected from MSBase and OFSEP, two large observational cohorts. Therapeutic lag was estimated for each patient based on their demographic and clinical characteristics. Propensity score was used to match patients treated with high and low-efficacy therapies. Outcomes after disregarding the period of therapeutic lag were compared in paired, pairwise-censored analyses. RESULTS: 1000 patients were included in the primary analysis. Patients with active SPMS treated with high-efficacy therapy experienced less frequent relapses than those on low-efficacy therapy (hazard ratio [HR] 0.7, p=0.006). In patients with inactive SPMS, there was no evidence for a difference in relapse frequency between groups (HR=0.8,p=0.39). No evidence for a difference in the risk of disability progression was observed. CONCLUSION: In treated patients with SPMS, high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active, but not those with inactive, SPMS. However, more potent therapies do not offer an advantage in reducing disability progression in this patient group. CLASSIFICATION OF EVIDENCE: This study provides class III evidence that high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active SPMS whilst we did not find a difference in disability progression between patients treated with high- and low-efficacy therapy.