Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry
- Autori: Pietro Iaffaldano 1, Giuseppe Lucisano 1 2, Tommaso Guerra 1, Francesco Patti 3 4, Eleonora Cocco 5, Giovanna De Luca 6, Vincenzo Brescia Morra 7, Carlo Pozzilli 8, Mauro Zaffaroni 9, Diana Ferraro 10, Claudio Gasperini 11, Giuseppe Salemi, Roberto Bergamaschi 13, Giacomo Lus 14, Matilde Inglese 15 16, Silvia Romano 17, Paolo Bellantonio 18, Elisabetta Di Monte 19, Giorgia Teresa Maniscalco 20, Antonella Conte 21 22, Alessandra Lugaresi 23 24, Marika Vianello 25, Valentina Liliana Adriana Torri Clerici 26, Alessia Di Sapio 27, Ilaria Pesci 28, Franco Granella 29, Rocco Totaro 30, Girolama Alessandra Marfia 31, Maura Chiara Danni 32, Paola Cavalla 33, Paola Valentino 34, Umberto Aguglia 35, Sara Montepietra 36, Elisabetta Ferraro 37, Alessandra Protti 38, Daniele Spitaleri 39, Carlo Avolio 40, Milena De Riz 41, Davide Maimone 42, Guido Cavaletti 43, Paola Gazzola 44, Gioacchino Tedeschi 45, Maria Sessa 46, Marco Rovaris 47, Franco Di Palma 48, Maurizia Gatto 49, Daniela Cargnelutti 50, Francesca De Robertis 51, Francesco Ottavio Logullo 52, Augusto Rini 53, Giuseppe Meucci 54, Bonaventura Ardito 55, Paola Banfi 56, Davide Nasuelli 57, Damiano Paolicelli 1, Maria Assunta Rocca 58, Emilio Portaccio 59, Clara Grazia Chisari 3 4, Giuseppe Fenu 5, Marco Onofrj 6, Antonio Carotenuto 7, Serena Ruggieri 8, Carla Tortorella 11, Paolo Ragonese, Mihaela Nica 60, Maria Pia Amato 59 61, Massimo Filippi 62, Maria Trojano 63; Italian MS Register
- Anno di pubblicazione: 2024
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/623475
Abstract
Background: Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD). Methods: RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs]. Results: A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs. Conclusions: More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.