Effectiveness and safety of switching to teriflunomide in older patients with relapsing multiple sclerosis: A real-world retrospective multicenter analysis

BACKGROUND

The prevalence of multiple sclerosis (MS) in older people is increasing due to population aging and availability of effective disease-modifying therapies (DMTs). Treating older people with MS is complicated by age-related and MS-related comorbidities, immunologic effects of prior DMTs, and immunosenescence. Teriflunomide is a once-daily oral immunomodulator that has demonstrated efficacy and acceptable safety in clinical trials of adults with relapsing forms of MS (RMS). However, there are limited clinical trial and real-world data regarding teriflunomide use in people with MS aged >55 years. We analyzed real-world data to assess the effectiveness and safety of teriflunomide in older people with RMS who had switched to this agent from other DMTs.

METHODS

People with RMS (relapsing remitting and active secondary progressive MS) aged ≥55 years who had switched from other DMTs to teriflunomide (7 mg or 14 mg) for ≥1 year were identified retrospectively by chart review at four sites in the United States. Data were extracted from medical records from 1 year pre-index to 2 years post-index (index defined as the teriflunomide start date). Assessments of effectiveness included annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging (MRI) outcomes. Assessments of safety included lymphocyte counts, infections, and malignancies. We examined the effectiveness outcomes and lymphocyte counts within sub-groups defined by age (55-64, ≥65 years), sex, MS type, and prior route of DMT administration (oral, injectable, infusible).

RESULTS

In total, 182 patients with RMS aged ≥55 years who switched from other DMTs to teriflunomide were identified (mean [SD] age: 62.5 [5.4] years). Mean ARR decreased from the start of teriflunomide treatment (mean [SD]: 0.43 [0.61]) to year 1 post-index (0.13 [0.65]) and year 2 post-index (0.05 [0.28]). Mean EDSS score remained unchanged from index (mean [SD]: 4.5 [1.8]) to 1 year post-treatment (4.5 [1.8]) and increased slightly at 2 years post-treatment (4.7 [1.7]). MRI scans from index and years 1 and 2 post-index compared with scans from the previous year indicated that most patients had stable or improved MRI outcomes at index (87.7%) and remained stable or improved at years 1 (96.0%) and 2 (93.6%). Lymphopenia decreased at years 1 (21.4%) and 2 post-index (14.8%, compared to index (23.5%). By 1 year post-index, fewer patients had grade 3 or 4 lymphopenia, and at 2 years post-index, there were no patients with grade 3 or 4 lymphopenia. Infection incidence was low (n = 40, 22.0%) and none were related to teriflunomide. The decreases in lymphopenia were driven by decreases among people who switched from a prior oral DMT; there were no notable differences in lymphopenia across the other sub-groups examined. ARR, EDSS score, and MRI outcomes across all sub-groups were similar to the results of the overall population.

CONCLUSION

Our multicenter, longitudinal, retrospective study demonstrated that patients with RMS aged 55 or older switching to teriflunomide from other DMTs had significantly improved ARR, stable disability, and stable or improved MRI over up to 2 years' follow up. Safety results were acceptable with fewer patients exhibiting lymphopenia at years 1 and 2 post-index.

Initial investigation OF 222Rn in the Tbilisi urban environment

Georgia has geological formations with high uranium content, and several buildings are built with local materials. This can create potentially high radon exposures. Consequently, studies to mitigate these exposures have been started. This study presents a preliminary investigation of radon in Tbilisi, the capital of Georgia. An independent radiological monitoring program in Georgia has been initiated by the Radiocarbon and Low-Level Counting Section of I. Javakhishvili Tbilisi State University with the cooperation of the Environmental Monitoring Laboratory of the Physics/Health Physics Department at Idaho State University. At this initial stage the E-PERM systems and GammaTRACER were used for the measurement of gamma exposure and radon concentrations in air and water. Measurements in Sololaki, a densely populated historic district of Tbilisi, revealed indoor radon (222Rn) concentrations of 1.5-2.5 times more than the U.S. Environmental Protection Agency action level of 148 Bq m(-3) (4 pCi L(-1)). Moreover, radon-in-air concentrations of 440 Bq m(-3) and 3,500 Bq m(-3) were observed at surface borehole openings within the residential district. Measurements of water from various tap water supplies displayed radon concentrations of 3-5 Bq L(-1) while radon concentrations in water from the hydrogeological and thermal water boreholes were 5-19 Bq L(-1). In addition, the background gamma absorbed dose rate in air ranged of 70-115 nGy h(-1) at the radon test locations throughout the Tbilisi urban environment.