Giulio Disanto, Sabine Schaedelin, Johanna Oechtering, Johannes Lorscheider, Riccardo Galbusera, Sebastian Finkener, Lutz Achtnichts, Patrice Lalive, Stefanie Müller, Caroline Pot, Robert Hoepner, Anke Salmen, Chiara Zecca, Lars G Hemkens, Marcus D'Souza, Bettina Fischer-Barnicol, Renaud Du Pasquier, Patrick Roth, Özgür Yaldizli, Maximilian Einsiedler, Tobias Derfuss, Ludwig Kappos, Claudio Gobbi, Cristina Granziera, Marjolaine Uginet, Aleksandra Maleska Maceski, Keltie McDonald, David Leppert, Pascal Benkert, Jens Kuhle
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Clinical trials directly comparing these treatments are lacking.</p><p><strong>Objective: </strong>To compare the risk of treatment discontinuation, relapse, and confirmed disability worsening in patients starting BCDT vs other DMT within real-world settings.</p><p><strong>Methods: </strong>In a longitudinal cohort study, patients with relapsing MS starting BCDT (ocrelizumab/rituximab, <i>n</i> = 269) after enrolment into the Swiss MS Cohort (SMSC) were evaluated for treatment discontinuation, occurrence of relapses, and disability worsening in comparison with platform (<i>n</i> = 57) and oral (<i>n</i> = 454) DMT, or natalizumab (<i>n</i> = 73) using Cox regression with double robust adjustment for baseline covariates.</p><p><strong>Results: </strong>Patients starting BCDT were less likely to discontinue treatment than all other DMT combined (HR = 0.26, 95% CI = 0.18-0.36, <i>p</i> < .01), oral DMT (HR = 0.28, 95% CI = 0.20-0.39, <i>p</i> < .01) and natalizumab (HR = 0.35, 95% CI = 0.21-0.58, <i>p</i> < .01). BCDT were associated with lower risk of relapses as compared to oral DMT HR = 0.59, 95% CI = 0.39-0.88, <i>p</i> < .01), but not to natalizumab (HR = 0.90, 95% CI = 0.45-1.82, <i>p</i> = .778). Disability worsening was not significantly different between treatment groups.</p><p><strong>Conclusion: </strong>We provide real-world evidence for patients being more persistent to BCDT than to other treatments, and better clinical outcomes may partly explain this.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251315457"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866361/pdf/","citationCount":"0","resultStr":"{\"title\":\"Treatment persistence and clinical outcomes in patients starting B cell depleting therapies within the Swiss MS Cohort.\",\"authors\":\"Giulio Disanto, Sabine Schaedelin, Johanna Oechtering, Johannes Lorscheider, Riccardo Galbusera, Sebastian Finkener, Lutz Achtnichts, Patrice Lalive, Stefanie Müller, Caroline Pot, Robert Hoepner, Anke Salmen, Chiara Zecca, Lars G Hemkens, Marcus D'Souza, Bettina Fischer-Barnicol, Renaud Du Pasquier, Patrick Roth, Özgür Yaldizli, Maximilian Einsiedler, Tobias Derfuss, Ludwig Kappos, Claudio Gobbi, Cristina Granziera, Marjolaine Uginet, Aleksandra Maleska Maceski, Keltie McDonald, David Leppert, Pascal Benkert, Jens Kuhle\",\"doi\":\"10.1177/20552173251315457\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Persistence to B cell depleting therapies (BCDT) like ocrelizumab and rituximab may be higher compared with other disease-modifying therapies (DMT) in multiple sclerosis (MS). Clinical trials directly comparing these treatments are lacking.</p><p><strong>Objective: </strong>To compare the risk of treatment discontinuation, relapse, and confirmed disability worsening in patients starting BCDT vs other DMT within real-world settings.</p><p><strong>Methods: </strong>In a longitudinal cohort study, patients with relapsing MS starting BCDT (ocrelizumab/rituximab, <i>n</i> = 269) after enrolment into the Swiss MS Cohort (SMSC) were evaluated for treatment discontinuation, occurrence of relapses, and disability worsening in comparison with platform (<i>n</i> = 57) and oral (<i>n</i> = 454) DMT, or natalizumab (<i>n</i> = 73) using Cox regression with double robust adjustment for baseline covariates.</p><p><strong>Results: </strong>Patients starting BCDT were less likely to discontinue treatment than all other DMT combined (HR = 0.26, 95% CI = 0.18-0.36, <i>p</i> < .01), oral DMT (HR = 0.28, 95% CI = 0.20-0.39, <i>p</i> < .01) and natalizumab (HR = 0.35, 95% CI = 0.21-0.58, <i>p</i> < .01). BCDT were associated with lower risk of relapses as compared to oral DMT HR = 0.59, 95% CI = 0.39-0.88, <i>p</i> < .01), but not to natalizumab (HR = 0.90, 95% CI = 0.45-1.82, <i>p</i> = .778). 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引用次数: 0
摘要
背景：与其他疾病改善疗法（DMT）相比，在多发性硬化症（MS）中，B细胞消耗疗法（BCDT）如ocrelizumab和rituximab的持久性可能更高。目前还缺乏直接比较这些治疗方法的临床试验。目的：比较现实环境中开始BCDT和其他DMT的患者停药、复发和确认残疾恶化的风险。方法：在一项纵向队列研究中，加入瑞士MS队列（SMSC）的复发性MS患者开始使用BCDT (ocrelizumab/rituximab, n = 269)，与平台（n = 57）和口服（n = 454） DMT或natalizumab （n = 73）相比，使用Cox回归评估治疗中断、复发发生和残疾恶化情况。结果：开始BCDT治疗的患者停止治疗的可能性低于所有其他DMT联合治疗（HR = 0.26, 95% CI = 0.18-0.36, p p p p = .778）。治疗组间残疾恶化无显著差异。结论：我们提供了BCDT患者比其他治疗更持久的现实证据，更好的临床结果可能部分解释了这一点。
Treatment persistence and clinical outcomes in patients starting B cell depleting therapies within the Swiss MS Cohort.
Background: Persistence to B cell depleting therapies (BCDT) like ocrelizumab and rituximab may be higher compared with other disease-modifying therapies (DMT) in multiple sclerosis (MS). Clinical trials directly comparing these treatments are lacking.
Objective: To compare the risk of treatment discontinuation, relapse, and confirmed disability worsening in patients starting BCDT vs other DMT within real-world settings.
Methods: In a longitudinal cohort study, patients with relapsing MS starting BCDT (ocrelizumab/rituximab, n = 269) after enrolment into the Swiss MS Cohort (SMSC) were evaluated for treatment discontinuation, occurrence of relapses, and disability worsening in comparison with platform (n = 57) and oral (n = 454) DMT, or natalizumab (n = 73) using Cox regression with double robust adjustment for baseline covariates.
Results: Patients starting BCDT were less likely to discontinue treatment than all other DMT combined (HR = 0.26, 95% CI = 0.18-0.36, p < .01), oral DMT (HR = 0.28, 95% CI = 0.20-0.39, p < .01) and natalizumab (HR = 0.35, 95% CI = 0.21-0.58, p < .01). BCDT were associated with lower risk of relapses as compared to oral DMT HR = 0.59, 95% CI = 0.39-0.88, p < .01), but not to natalizumab (HR = 0.90, 95% CI = 0.45-1.82, p = .778). Disability worsening was not significantly different between treatment groups.
Conclusion: We provide real-world evidence for patients being more persistent to BCDT than to other treatments, and better clinical outcomes may partly explain this.
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