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Old 05-07-2019, 05:28 PM
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And another study. Younger the better... -D

Higher Efficacy Therapies Appear to have a Disproportionately Larger Effect in Younger
Patients with Multiple Sclerosis


Brandi Vollmer, et al
University of Colorado

Objective: Identify baseline characteristics associated with future disease activity in multiple sclerosis(MS) patients comparing oral and infusible disease modifying therapies(DMTs).

Background:
Our previous studies demonstrated higher effectiveness with infusible DMTs (rituximab, natalizumab) over oral DMTs (fingolimod, dimethyl fumarate), however, many patients do well on oral DMTs. Identifying patients likely to experience disease activity in clinical practice is still a challenge.

Design/Methods: Relapsing-remitting MS Patients prescribed fingolimod, dimethyl fumarate, natalizumab or rituximab at the Rocky Mountain MS Center at the University of Colorado were followed for 24 months or until drug discontinuation. Patients receiving oral (fingolimod, dimethyl fumarate) versus infusible (natalizumab, rituximab) were evaluated for disease activity, defined as experiencing a clinical relapse, new T2 lesion and/or gadolinium enhancing lesion(GdE).

Results:
Of the 1004 patients analyzed, 509 received oral DMTs and 495 received infusible DMTs. In the oral DMT group, 36.4% experienced disease activity versus 21.2% in the infusible DMT group. Oral patients experiencing disease activity were younger(p<0.001), had lower disease duration(p=0.010) and were more likely to have GdE on baseline MRI(p=0.015) than those who did not experience disease activity. Those <45 years had greater odds of experiencing disease activity overall(OR=2.06,p<0.001), clinical relapse(OR=2.20,p=0.008), new T2
lesion(OR=2.95,p<0.001), or
dE(OR=3.35,p<0.001) compared to those ≥45 years. Infusible patients experiencing disease activity were younger(p=0.021) and were more likely to have GdE on baseline MRI(p=0.036). Those <45 years had similar odds of experiencing disease activity overall(OR=1.35,p=0.232), clinical relapse(OR=1.16,p=0.726), new T2 lesion(OR=1.02,p=0.952), or GdE(OR=2.662,p=0.2013) compared to
those ≥45 years. The odds of experiencing disease activity with oral versus infusible DMTs is greater in younger patients (<45 years:OR=2.67,p<0.001) than older patients (≥45 years:OR=1.75,p=0.033).

Conclusions: Future disease activity is independently associated with younger patients and GdE lesions at baseline. There is a benefit to treating patients ≥45 years of age. Higher efficacy therapies appear to have a disproportionately larger effect on younger patients.
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