Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry
- Authors: 1, P.I.; 1 2, G.L.; 1, T.G.; 3 4, F.P.; 5, E.C.; 6, G.D.L.; 7, V.B.M.; 8, C.P.; 9, M.Z.; Ferraro 10, D.; Gasperini 11, C.; Salemi, G.; Bergamaschi 13, R.; Lus 14, G.; Inglese 15 16, M.; Romano 17, S.; Bellantonio 18, P.; Di Monte 19, E.; Teresa Maniscalco 20, G.; Conte 21 22, A.; Lugaresi 23 24, A.; Vianello 25, M.; Liliana Adriana Torri Clerici 26, V.; Di Sapio 27, A.; Pesci 28, I.; Granella 29, F.; Totaro 30, R.; Alessandra Marfia 31, G.; Chiara Danni 32, M.; Cavalla 33, P.; Valentino 34, P.; Aguglia 35, U.; Montepietra 36, S.; Ferraro 37, E.; Protti 38, A.; Spitaleri 39, D.; Avolio 40, C.; De Riz 41, M.; Maimone 42, D.; Cavaletti 43, G.; Gazzola 44, P.; Tedeschi 45, G.; Sessa 46, M.; Rovaris 47, M.; Di Palma 48, F.; Gatto 49, M.; Cargnelutti 50, D.; De Robertis 51, F.; Ottavio Logullo 52, F.; Rini 53, A.; Meucci 54, G.; Ardito 55, B.; Banfi 56, P.; Nasuelli 57, D.; 1, D.P.; Assunta Rocca 58, M.; Portaccio 59, E.; 3 4, C.G.C.; 5, G.F.; 6, M.O.; 7, A.C.; 8, S.R.; Tortorella 11, C.; Ragonese, P.; Nica 60, M.; Pia Amato 59 61, M.; Filippi 62, M.; Trojano 63, M.; Ms Register, I.
- Publication year: 2024
- Type: 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.