The role of disease modifying therapies in late-onset multiple sclerosis: A Portuguese multicentric characterization study

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-11-04 DOI:10.1016/j.msard.2024.106153

Patrícia Faustino , Diana Marques Cruz , Catarina Fernandes , Andressa Pereira , Roberto Franco , Sara Costa , Sara Matos , Armando Morganho , Carla Fraga , Ernestina Santos , Filipa Ladeira , Mónica Santos , Pedro Abreu , Sónia Batista , José Vale , Maria José Sá , Mariana Santos

{"title":"The role of disease modifying therapies in late-onset multiple sclerosis: A Portuguese multicentric characterization study","authors":"Patrícia Faustino , Diana Marques Cruz , Catarina Fernandes , Andressa Pereira , Roberto Franco , Sara Costa , Sara Matos , Armando Morganho , Carla Fraga , Ernestina Santos , Filipa Ladeira , Mónica Santos , Pedro Abreu , Sónia Batista , José Vale , Maria José Sá , Mariana Santos","doi":"10.1016/j.msard.2024.106153","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Knowledge about the effect of disease modifying treatment (DMT) in late-onset multiple sclerosis (LOMS, onset ≥50 years-old) is scarce. This study aims to evaluate the association between DMT use and multiple sclerosis (MS) evolution in a LOMS cohort.</div></div><div><h3>Methods</h3><div>This multicentre, retrospective and observational study included LOMS patients with ≥2 years of follow-up. Data on demographics, clinical/paraclinical (baseline and follow-up), DMT and adverse events were collected. Primary outcomes were irreversible EDSS 4.0 and 6.0 achievement and first year ARR. Univariate and multivariate regression models were conducted, with treated and/or relapsing phenotypes (RMS) subgroups analyses.</div></div><div><h3>Results</h3><div>We included 232 patients (53.4 % with RRMS phenotype; 84.9 % submitted to DMT; median follow-up time of 141.5 (IQR 92.7–193.1) months). Treatment versus non-treatment did not affect EDSS milestones in multivariate analysis (adjusted to phenotype, baseline EDSS, age, and ARR), but initially receiving monoclonal antibodies (MAbs) was associated with lower odds of EDSS 4.0 (OR 0.13). In treated patients, starting with high efficacy DMT (HE-DMT) was related to a lower chance of EDSS 4.0 (OR 0.05) and 6.0 (OR 0.26) compared with being exclusively treated with moderate efficacy DMT (ME-DMT), with similar results when analysing the subgroup of RMS treated patients. In multivariate models, initial treatment with MAbs (vs. non-treatment) and with HE-DMT (vs. ME-DMT) were related to a lower first year ARR; when considering only RMS patients, every DMT class analysed reduced first year ARR vs. non-treatment. During DMT, we documented a rate of 0.6 % serious infections, 0.07 % opportunistic infections and 0.7 % neoplasm diagnosis per patient year.</div></div><div><h3>Conclusion</h3><div>DMT type and therapeutic strategy influenced LOMS disability accumulation and relapses in our cohort. Our findings support the importance of investment in LOMS treatment optimization.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106153"},"PeriodicalIF":2.9000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Multiple sclerosis and related disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2211034824007296","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Knowledge about the effect of disease modifying treatment (DMT) in late-onset multiple sclerosis (LOMS, onset ≥50 years-old) is scarce. This study aims to evaluate the association between DMT use and multiple sclerosis (MS) evolution in a LOMS cohort.

Methods

This multicentre, retrospective and observational study included LOMS patients with ≥2 years of follow-up. Data on demographics, clinical/paraclinical (baseline and follow-up), DMT and adverse events were collected. Primary outcomes were irreversible EDSS 4.0 and 6.0 achievement and first year ARR. Univariate and multivariate regression models were conducted, with treated and/or relapsing phenotypes (RMS) subgroups analyses.

Results

We included 232 patients (53.4 % with RRMS phenotype; 84.9 % submitted to DMT; median follow-up time of 141.5 (IQR 92.7–193.1) months). Treatment versus non-treatment did not affect EDSS milestones in multivariate analysis (adjusted to phenotype, baseline EDSS, age, and ARR), but initially receiving monoclonal antibodies (MAbs) was associated with lower odds of EDSS 4.0 (OR 0.13). In treated patients, starting with high efficacy DMT (HE-DMT) was related to a lower chance of EDSS 4.0 (OR 0.05) and 6.0 (OR 0.26) compared with being exclusively treated with moderate efficacy DMT (ME-DMT), with similar results when analysing the subgroup of RMS treated patients. In multivariate models, initial treatment with MAbs (vs. non-treatment) and with HE-DMT (vs. ME-DMT) were related to a lower first year ARR; when considering only RMS patients, every DMT class analysed reduced first year ARR vs. non-treatment. During DMT, we documented a rate of 0.6 % serious infections, 0.07 % opportunistic infections and 0.7 % neoplasm diagnosis per patient year.

Conclusion

DMT type and therapeutic strategy influenced LOMS disability accumulation and relapses in our cohort. Our findings support the importance of investment in LOMS treatment optimization.

查看原文本刊更多论文

疾病调整疗法在晚发性多发性硬化症中的作用：葡萄牙多中心特征研究

简介有关晚发性多发性硬化症（LOMS，发病年龄≥50岁）中疾病修饰治疗（DMT）效果的知识很少。本研究旨在评估晚发性多发性硬化症队列中使用 DMT 与多发性硬化症（MS）演变之间的关联：这项多中心、回顾性和观察性研究纳入了随访时间≥2年的LOMS患者。研究收集了人口统计学、临床/辅助临床（基线和随访）、DMT和不良事件的数据。主要结果是EDSS 4.0和6.0的不可逆成就以及第一年的ARR。我们建立了单变量和多变量回归模型，并对治疗和/或复发表型（RMS）进行了亚组分析：我们纳入了232名患者（53.4%为RRMS表型；84.9%接受了DMT治疗；中位随访时间为141.5（IQR 92.7-193.1）个月）。在多变量分析（根据表型、基线EDSS、年龄和ARR进行调整）中，治疗与非治疗并不影响EDSS里程碑，但最初接受单克隆抗体（MAbs）治疗与较低的EDSS 4.0几率相关（OR 0.13）。在接受治疗的患者中，与只接受中效 DMT（ME-DMT）治疗的患者相比，开始接受高效 DMT（HE-DMT）治疗的患者出现 EDSS 4.0（OR 0.05）和 6.0（OR 0.26）的几率较低；在对接受 RMS 治疗的患者亚组进行分析时，结果类似。在多变量模型中，最初接受 MAbs 治疗（与未接受治疗相比）和接受 HE-DMT 治疗（与 ME-DMT 相比）与较低的首年 ARR 有关；如果仅考虑 RMS 患者，所分析的每一类 DMT 与未接受治疗相比都会降低首年 ARR。在DMT治疗期间，我们记录了每名患者每年0.6%的严重感染率、0.07%的机会性感染率和0.7%的肿瘤诊断率：结论：DMT类型和治疗策略影响了我们队列中LOMS的残疾累积和复发。我们的研究结果支持对LOMS治疗优化进行投资的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.