Tweet
Big Multiple Sclerosis Data Network: impact of early treatment on long term disability accumulation in relapsing remitting multiple sclerosis patients
ECTRIMS Online Library. Iaffaldano P. Oct 27, 2017; 199874
Abstract: P1854
Type: Poster
Abstract Category: Late breaking news
Background: Results from different randomized clinical trials support the early treatment of multiple sclerosis (MS). To date no real-life data have been provided to support the very long-term impact of such treatment strategy.
Objectives: A pilot study using data pooled from 5 different MS registries, the Big MS Data (BMSD) Network evaluated the impact of the time to the first disease modifying drug (DMD) start on the long term disability accumulation in relapsing MS (RRMS).
Methods: A cohort of first-line DMD-treated (Interferon-beta, Glatiramer Acetate, Azathioprine) RRMS patients, with a minimum follow-up of 10 years, a minimum cumulative DMDs exposure of 3 years and at least 3 Expanded Disability Status Scale (EDSS) score evaluations was selected from the pooled cohort of the BMSD Network. Cox proportional hazards regression models were used to assess the risk of reaching the EDSS 4.0 and 6.0 including as covariates: age at onset, sex, baseline EDSS, number of relapse before DMD start, number of relapses after DMD start (included as time-dependent covariate), time from disease onset to the first DMD start (included as quintiles) and the number of EDSS evaluations performed during the follow-up.
Results: A cohort of 12,286 RRMS patients (Female 8,625 (70.4%)) was retrieved. The median(Interquartile range) follow-up was 13.6(11.7-16.2) years, the median time to the first DMD start was 4.4(1.7-9.6) years, the median DMD exposure was 9.2(5.7-12.2) years. The 1st quintile of time to DMD start included patients treated within 1 year after the disease onset (0.7(0.4-1.0) years). During the follow-up an irreversible EDSS score of 4.0 and 6.0 was reached by 3,677 (34.6%) and 2,193 (18.3%) patients, respectively. The multivariate models for the risk of attaining EDSS 4.0 and EDSS 6.0 both revealed a significant association with the time to first DMD start. Patients belonging to the 2nd, 3rd, 4th and 5th quintile of the time from disease onset to the first DMD start were all at higher risk for developing irreversible disability (EDSS 4.0: HR 95% CI: 1.23(1.10-1.37), 1.35(1.21-1.51), 1.51(1.34-1.69), 1.81(1.60-2.06), respectively; EDSS 6.0: 1.26(1.07-1.49), 1.53(1.31-1.79), 1.76(1.50-2.06), 1.96(1.65-2.32), respectively) in comparison to patients belonging to the 1st quintile.
Conclusions: Real-world data from the BMSD network confirm the effectiveness of the early treatment strategy in delaying the accumulation of irreversible disability in RRMS patients.
ECTRIMS Online Library. Iaffaldano P. Oct 27, 2017; 199874
Abstract: P1854
Type: Poster
Abstract Category: Late breaking news
Background: Results from different randomized clinical trials support the early treatment of multiple sclerosis (MS). To date no real-life data have been provided to support the very long-term impact of such treatment strategy.
Objectives: A pilot study using data pooled from 5 different MS registries, the Big MS Data (BMSD) Network evaluated the impact of the time to the first disease modifying drug (DMD) start on the long term disability accumulation in relapsing MS (RRMS).
Methods: A cohort of first-line DMD-treated (Interferon-beta, Glatiramer Acetate, Azathioprine) RRMS patients, with a minimum follow-up of 10 years, a minimum cumulative DMDs exposure of 3 years and at least 3 Expanded Disability Status Scale (EDSS) score evaluations was selected from the pooled cohort of the BMSD Network. Cox proportional hazards regression models were used to assess the risk of reaching the EDSS 4.0 and 6.0 including as covariates: age at onset, sex, baseline EDSS, number of relapse before DMD start, number of relapses after DMD start (included as time-dependent covariate), time from disease onset to the first DMD start (included as quintiles) and the number of EDSS evaluations performed during the follow-up.
Results: A cohort of 12,286 RRMS patients (Female 8,625 (70.4%)) was retrieved. The median(Interquartile range) follow-up was 13.6(11.7-16.2) years, the median time to the first DMD start was 4.4(1.7-9.6) years, the median DMD exposure was 9.2(5.7-12.2) years. The 1st quintile of time to DMD start included patients treated within 1 year after the disease onset (0.7(0.4-1.0) years). During the follow-up an irreversible EDSS score of 4.0 and 6.0 was reached by 3,677 (34.6%) and 2,193 (18.3%) patients, respectively. The multivariate models for the risk of attaining EDSS 4.0 and EDSS 6.0 both revealed a significant association with the time to first DMD start. Patients belonging to the 2nd, 3rd, 4th and 5th quintile of the time from disease onset to the first DMD start were all at higher risk for developing irreversible disability (EDSS 4.0: HR 95% CI: 1.23(1.10-1.37), 1.35(1.21-1.51), 1.51(1.34-1.69), 1.81(1.60-2.06), respectively; EDSS 6.0: 1.26(1.07-1.49), 1.53(1.31-1.79), 1.76(1.50-2.06), 1.96(1.65-2.32), respectively) in comparison to patients belonging to the 1st quintile.
Conclusions: Real-world data from the BMSD network confirm the effectiveness of the early treatment strategy in delaying the accumulation of irreversible disability in RRMS patients.
Comment