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Saccà F, Lanzillo R, Signori A, Maniscalco GT, Signoriello E, Lo Fermo S, Repice A, Annovazzi P, Baroncini D, Clerico M, Binello E, Cerqua R, Mataluni G, Bonavita S, Lavorgna L, Zarbo IR, Laroni A, Rossi S, Pareja Gutierrez L, La Gioia S, Frigeni B, Barcella V, Frau J, Cocco E, Fenu G, Torri Clerici V, Sartori A, Rasia S, Cordioli C, Di Sapio A, Pontecorvo S, Grasso R, Barrilà C, Russo CV, Esposito S, Ippolito D, Bovis F, Gallo F, Sormani MP. Determinants of therapy switch in multiple sclerosis treatment-naïve patients: A real-life study. Mult Scler 2018; 25:1263-1272. [DOI: 10.1177/1352458518790390] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: With many options now available, first therapy choice is challenging in multiple sclerosis (MS) and depends mainly on neurologist and patient preferences. Objectives: To identify prognostic factors for early switch after first therapy choice. Methods: Newly diagnosed relapsing–remitting MS patients from 24 Italian centers were included. We evaluated the association of baseline demographics, clinical, and magnetic resonance imaging (MRI) data to the switch probability for lack of efficacy or intolerance/safety with a multivariate Cox analysis and estimated switch rates by competing risks models. Results: We enrolled 3025 patients. The overall switch frequency was 48% after 3 years. Switch risk for lack of efficacy was lower with fingolimod (hazard ratio (HR) = 0.50; p = 0.009), natalizumab (HR = 0.13; p < 0.001), dimethyl-fumarate (HR = 0.60; p = 0.037), teriflunomide (HR = 0.21; p = 0.031) as compared to interferons. Younger age (HR = 0.96; p < 0.001), diagnosis delay (HR = 1.23; p = 0.021), higher baseline Expanded Disability Status Scale (HR = 1.17; p = 0.001), and spinal cord lesions (HR = 1.46; p = 0.001) were independently associated with higher inefficacy switch rates. We found lower switch for intolerance/safety with glatiramer acetate (HR = 0.61; p = 0.001), fingolimod (HR = 0.35; p = 0.002), and dimethyl-fumarate (HR = 0.57; p = 0.022) as compared to interferons, while it increased with natalizumab (HR = 1.43; p = 0.022). Comorbidities were associated with intolerance switch (HR = 1.28; p = 0.047). Conclusion: Several factors are associated with higher switch risk in patients starting a first-line therapy and could be integrated in the decision-making process of first treatment choice.
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Affiliation(s)
- Francesco Saccà
- Multiple Sclerosis Center, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Center, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Giorgia T Maniscalco
- Neurological Clinic and Multiple Sclerosis Center, “AORN A.Cardarelli,” Naples, Italy
| | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Salvatore Lo Fermo
- Neurological Clinic, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Annamaria Repice
- 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center), Careggi University Hospital and University of Florence, Florence, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Gallarate, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Gallarate, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Eleonora Binello
- Centro Sclerosi Multipla, Dipartimento di Neuroscienze, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Raffaella Cerqua
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | | | - Simona Bonavita
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Lavorgna
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ignazio Roberto Zarbo
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Alice Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR) and IRCCS San Martino-IST, University of Genova, Genova, Italy
| | - Silvia Rossi
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Lorena Pareja Gutierrez
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Sara La Gioia
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Barbara Frigeni
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Valeria Barcella
- Centro Sclerosi Multipla, ASST Papa Giovanni XXIII di Bergamo, Bergamo, Italy
| | - Jessica Frau
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Valentina Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Arianna Sartori
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
| | - Sarah Rasia
- Multiple Sclerosis Center, ASST Spedali Civili, PO di Montichiari (BS), Montichiari, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili, PO di Montichiari (BS), Montichiari, Italy
| | - Alessia Di Sapio
- 2nd Neurology Unit and CRRSM (Regional Referral Multiple Sclerosis Center), AOU San Luigi Gonzaga, Torino, Italy; Regina Montis Regalis Hospital, Mondovì, Italy
| | - Simona Pontecorvo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | | | - Cinzia Valeria Russo
- Multiple Sclerosis Center, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Sabrina Esposito
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Domenico Ippolito
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Fabio Gallo
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genova, Genova, Italy
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Lanzillo R, Carotenuto A, Moccia M, Saccà F, Russo CV, Massarelli M, De Rosa A, Brescia Morra V. A longitudinal real-life comparison study of natalizumab and fingolimod. Acta Neurol Scand 2017; 136:217-222. [PMID: 27976804 DOI: 10.1111/ane.12718] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Different retrospective studies compared natalizumab and fingolimod in relapsing-remitting multiple sclerosis (RRMS), with conflicting results. We aimed to explore the prescriptive attitude and the clinical outcome of the two therapies. METHODS We retrospectively included all RRMS patients treated with natalizumab (n=101) or fingolimod (n=78) as their first second-line therapy with at least 24-month follow-up. Demographic and clinical features were recorded to calculate the propensity score (PS). Outcomes of interest were annualized relapse rate (ARR), risk of relapse, and change in the EDSS RESULTS: At baseline, natalizumab patients were younger and had a shorter disease duration, a higher number of relapse in 1 year (1yR) and 2 years (2yR) and overall (ARR-PT) pretherapy, compared to fingolimod patients. On therapy, the proportion of relapsing patients and the mean RR were similar in the two groups. However, the change in the ARR was higher in natalizumab than in fingolimod group (P<.002), but, using PS as a covariate, it was comparable (P=.960). Similarly, the change in EDSS was significantly different for the two groups (P<.004), but not after adjusting for the PS (P=.321). CONCLUSION We observed a comparable efficacy on ARR reduction and on EDSS progression with natalizumab and fingolimod correcting through PS, suggesting that the efficacy difference observed before correction might derive from the clinical attitude in prescribing natalizumab in more active MS patients in real life.
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Affiliation(s)
- R. Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - A. Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - M. Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - F. Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - C. V. Russo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - M. Massarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - A. De Rosa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - V. Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
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