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Variability of the Response to Immunotherapy Among Subgroups of Patients With Multiple Sclerosis Publisher Pubmed



Diouf I1 ; Malpas CB1, 2 ; Sharmin S1 ; Roos I1, 2 ; Horakova D3 ; Havrdova EK3 ; Patti F4 ; Shaygannejad V5 ; Ozakbas S6 ; Izquierdo G7 ; Eichau S7 ; Onofrj M8 ; Lugaresi A9, 10 ; Alroughani R11 Show All Authors
Authors
  1. Diouf I1
  2. Malpas CB1, 2
  3. Sharmin S1
  4. Roos I1, 2
  5. Horakova D3
  6. Havrdova EK3
  7. Patti F4
  8. Shaygannejad V5
  9. Ozakbas S6
  10. Izquierdo G7
  11. Eichau S7
  12. Onofrj M8
  13. Lugaresi A9, 10
  14. Alroughani R11
  15. Prat A12
  16. Girard M12
  17. Duquette P12
  18. Terzi M13
  19. Boz C14
  20. Grandmaison F15
  21. Hamdy S16
  22. Sola P17
  23. Ferraro D17
  24. Grammond P18
  25. Turkoglu R19
  26. Buzzard K20
  27. Skibina O20
  28. Yamout B21
  29. Altintas A22, 23
  30. Gerlach O24
  31. Van Pesch V25
  32. Blanco Y26
  33. Maimone D27
  34. Lechnerscott J28
  35. Bergamaschi R29
  36. Karabudak R30
  37. Iuliano G31
  38. Mcguigan C32
  39. Cartechini E33
  40. Barnett M34
  41. Hughes S35
  42. Sa MJ36
  43. Solaro C37, 38
  44. Kappos L39
  45. Ramotello C40
  46. Cristiano E41
  47. Hodgkinson S42
  48. Spitaleri D43
  49. Soysal A44
  50. Petersen T45
  51. Slee M46
  52. Butler E47
  53. Granella F48
  54. De Gans K49
  55. Mccombe P50
  56. Ampapa R51
  57. Vanwijmeersch B52
  58. Van Der Walt A20, 53
  59. Butzkueven H54
  60. Prevost J55
  61. Sinnige LGF56
  62. Sanchezmenoyo JL57
  63. Vucic S58
  64. Laureys G59
  65. Vanhijfte L59
  66. Khurana D60
  67. Macdonell R54
  68. Gouider R61
  69. Castillotrivino T62
  70. Gray O63
  71. Agueramorales E64
  72. Alasmi A65
  73. Shaw C66
  74. Deri N67
  75. Alharbi T68
  76. Fragoso Y69
  77. Csepany T70
  78. Perezsempere A71
  79. Trevinofrenk I72
  80. Schepel J73
  81. Moore F74
  82. Kalincik T1, 2
Show Affiliations
Authors Affiliations
  1. 1. Department of Medicine, CORe, University of Melbourne, Melbourne, VIC, Australia
  2. 2. Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
  3. 3. Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
  4. 4. Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
  5. 5. Isfahan University of Medical Sciences, Isfahan, Iran
  6. 6. Dokuz Eylul University, Konak/Izmir, Turkey
  7. 7. Hospital Universitario Virgen Macarena, Seville, Spain
  8. 8. Department of Neuroscience, Imaging, and Clinical Sciences, D'Annunzio University, Chieti, Italy
  9. 9. IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
  10. 10. Dipartimento di Scienze Biomediche e Neuromotorie, Universita di Bologna, Bologna, Italy
  11. 11. Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
  12. 12. CHUM Mississippi Center and University of Montreal, Montreal, QC, Canada
  13. 13. School of Medicine, Ondokuz Mayis University, Samsun, Turkey
  14. 14. KTU Medical Faculty, Farabi Hospital, Trabzon, Turkey
  15. 15. Neuro Rive-Sud, Quebec City, QC, Canada
  16. 16. Neurology, Kasr Al Ainy MS Research Unit, Cairo, Egypt
  17. 17. Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
  18. 18. CISSS Chaudiere-Appalache, Levis, Sainte-Marie, QC, Canada
  19. 19. Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
  20. 20. Central Clinical School, Monash University, Melbourne, VIC, Australia
  21. 21. Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
  22. 22. Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey
  23. 23. Koc University Research Center for Translational Medicine, Istanbul, Turkey
  24. 24. Zuyderland Medical Center, Sittard-Geleen, Netherlands
  25. 25. Cliniques Universitaires Saint-Luc, Louvain, Brussels, Belgium
  26. 26. Center of Neuroimmunology, Service of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
  27. 27. Garibaldi Hospital, Catania, Italy
  28. 28. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  29. 29. IRCCS Mondino Foundation, Pavia, Italy
  30. 30. Hacettepe University, Ankara, Turkey
  31. 31. Ospedali Riuniti di Salerno, Salerno, Italy
  32. 32. St Vincent's University Hospital, Dublin, Ireland
  33. 33. UOC Neurologia, Azienda Sanitaria Unica Regionale Marche–AV3, Macerata, Italy
  34. 34. Brain and Mind Centre, Sydney, NSW, Australia
  35. 35. Royal Victoria Hospital, Belfast, United Kingdom
  36. 36. Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
  37. 37. Department of Neurology, ASL3 Genovese, Genoa, Italy
  38. 38. Department of Rehabilitation, ML Novarese Hospital Moncrivello, Genoa, Italy
  39. 39. Departments of Medicine and Clinical Research, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
  40. 40. Trias and Pujol Brothers University Hospital, Badalona, Spain
  41. 41. Hospital Italiano, Buenos Aires, Argentina
  42. 42. Liverpool Hospital, Sydney, NSW, Australia
  43. 43. Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
  44. 44. Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
  45. 45. Aarhus University Hospital, Aarhus, Denmark
  46. 46. Flinders University, Adelaide, SA, Australia
  47. 47. Monash Medical Centre, Melbourne, VIC, Australia
  48. 48. Department of Medicine and Surgery, University of Parma, Parma, Italy
  49. 49. Groene Hart Ziekenhuis, Gouda, Netherlands
  50. 50. University of Queensland, Brisbane, QLD, Australia
  51. 51. Nemocnice Jihlava, Jihlava, Czech Republic
  52. 52. Rehabilitation and MS Center Overpelt and Hasselt University, Hasselt, Belgium
  53. 53. Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
  54. 54. Austin Health, Melbourne, VIC, Australia
  55. 55. CSSS Saint-Jerome, Saint-Jerome, QC, Canada
  56. 56. Medical Center Leeuwarden, Leeuwarden, Netherlands
  57. 57. Hospital de Galdakao-Usansolo, Galdakao, Spain
  58. 58. Westmead Hospital, Sydney, NSW, Australia
  59. 59. University Hospital Ghent, Ghent, Belgium
  60. 60. Postgraduate Institute of Medical Education and Research, Chandigarh, India
  61. 61. Department of Neurology, Razi Hospital, Manouba, Tunisia
  62. 62. Instituto de Investigacion Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastian, Spain
  63. 63. South East Trust, Belfast, United Kingdom
  64. 64. University Hospital Reina Sofia, Cordoba, Spain
  65. 65. Department of Medicine, Sultan Qaboos University Hospital, Seeb, Oman
  66. 66. University Hospital Geelong, Geelong, VIC, Australia
  67. 67. Hospital Fernandez, Buenos Aires, Argentina
  68. 68. Neurology Department, King Fahad Specialist Hospital–Dammam, Dammam, Saudi Arabia
  69. 69. Universidade Metropolitana de Santos, Santos, Brazil
  70. 70. Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
  71. 71. Hospital General Universitario de Alicante, Alicante, Spain
  72. 72. Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
  73. 73. Waikato Hospital, Hamilton, New Zealand
  74. 74. Jewish General Hospital, Montreal, QC, Canada

Source: European Journal of Neurology Published:2023


Abstract

Background and purpose: This study assessed the effect of patient characteristics on the response to disease-modifying therapy (DMT) in multiple sclerosis (MS). Methods: We extracted data from 61,810 patients from 135 centers across 35 countries from the MSBase registry. The selection criteria were: clinically isolated syndrome or definite MS, follow-up ≥ 1 year, and Expanded Disability Status Scale (EDSS) score ≥ 3, with ≥1 score recorded per year. Marginal structural models with interaction terms were used to compare the hazards of 12-month confirmed worsening and improvement of disability, and the incidence of relapses between treated and untreated patients stratified by their characteristics. Results: Among 24,344 patients with relapsing MS, those on DMTs experienced 48% reduction in relapse incidence (hazard ratio [HR] = 0.52, 95% confidence interval [CI] = 0.45–0.60), 46% lower risk of disability worsening (HR = 0.54, 95% CI = 0.41–0.71), and 32% greater chance of disability improvement (HR = 1.32, 95% CI = 1.09–1.59). The effect of DMTs on EDSS worsening and improvement and the risk of relapses was attenuated with more severe disability. The magnitude of the effect of DMT on suppressing relapses declined with higher prior relapse rate and prior cerebral magnetic resonance imaging activity. We did not find any evidence for the effect of age on the effectiveness of DMT. After inclusion of 1985 participants with progressive MS, the effect of DMT on disability mostly depended on MS phenotype, whereas its effect on relapses was driven mainly by prior relapse activity. Conclusions: DMT is generally most effective among patients with lower disability and in relapsing MS phenotypes. There is no evidence of attenuation of the effect of DMT with age. © 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
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