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Title: Anti-inflammatory disease-modifying treatment and short-term disability progression in SPMS.
Authors: Lorscheider, Johannes
Jokubaitis, Vilija G
Spelman, Tim
Izquierdo, Guillermo
Lugaresi, Alessandra
Havrdova, Eva
Horakova, Dana
Trojano, Maria
Duquette, Pierre
Girard, Marc
Prat, Alexandre
Grand'Maison, François
Grammond, Pierre
Pucci, Eugenio
Boz, Cavit
Sola, Patrizia
Ferraro, Diana
Spitaleri, Daniele
Lechner-Scott, Jeanette
Terzi, Murat
Van Pesch, Vincent
Iuliano, Gerardo
Bergamaschi, Roberto
Ramo-Tello, Cristina
Granella, Franco
Oreja-Guevara, Celia
Butzkueven, Helmut
Kalincik, Tomas
MSBase Study Group
metadata.dc.subject.mesh: Adult
Anti-Inflammatory Agents
Area Under Curve
Disability Evaluation
Disease Progression
Follow-Up Studies
Longitudinal Studies
Magnetic Resonance Imaging
Middle Aged
Multiple Sclerosis, Chronic Progressive
Propensity Score
Proportional Hazards Models
Treatment Outcome
Issue Date: 9-Aug-2017
Abstract: To investigate the effect of disease-modifying treatment on short-term disability outcomes in secondary progressive multiple sclerosis (SPMS). Using MSBase, an international cohort study, we previously validated a highly accurate definition of SPMS. Here, we identified patients in MSBase who were either untreated or treated with a disease-modifying drug when meeting this definition. Propensity score matching was used to select subpopulations with comparable baseline characteristics. Disability outcomes were compared in paired, pairwise-censored analyses adjusted for treatment persistence, visit density, and relapse rates. Of the 2,381 included patients, 1,378 patients were matchable (treated n = 689, untreated n = 689). Median pairwise-censored follow-up was 2.1 years (quartiles 1.2-3.8 years). No difference in the risk of 6-month sustained disability progression was observed between the groups (hazard ratio [HR] 0.9, 95% confidence interval [CI] 0.7-1.1, p = 0.27). We also did not find differences in any of the secondary endpoints: risk of reaching Expanded Disability Status Scale (EDSS) score ≥7 (HR 0.6, 95% CI 0.4-1.1, p = 0.10), sustained disability reduction (HR 1.0, 95% CI 0.8-1.3, p = 0.79), or change in disability burden (area under the EDSS-time curve, β = -0.05, p = 0.09). Secondary and sensitivity analyses confirmed the results. Our pooled analysis of the currently available disease-modifying agents used after conversion to SPMS suggests that, on average, these therapies have no substantial effect on relapse-unrelated disability outcomes measured by the EDSS up to 4 years. This study provides Class IV evidence that for patients with SPMS, disease-modifying treatment has no beneficial effect on short-term disability progression.
metadata.dc.identifier.doi: 10.1212/WNL.0000000000004330
Appears in Collections:Producción 2020

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