Does initial high efficacy therapy in multiple sclerosis
surpass escalation treatment strategy? A comparison of patients
with relapsing-remitting multiple sclerosis in the Czech and
Swedish national multiple sclerosis registries

J 2023

Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries

HRNCIAROVA, Tereza, Jiri DRAHOTA, Tim SPELMAN, Jan HILLERT, Jan LYCKE et. al.

Basic information

Original name

Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries

Authors

HRNCIAROVA, Tereza (203 Czech Republic), Jiri DRAHOTA (203 Czech Republic), Tim SPELMAN (203 Czech Republic), Jan HILLERT (203 Czech Republic), Jan LYCKE (203 Czech Republic), Eva KUBALA HAVRDOVA (203 Czech Republic), Eva RECMANOVA (203 Czech Republic), Jana ADAMKOVA (203 Czech Republic), Jan MARES (203 Czech Republic), Jana LIBERTINOVA (203 Czech Republic), Zbysek PAVELEK (203 Czech Republic), Pavel HRADILEK (203 Czech Republic), Radek AMPAPA (203 Czech Republic), Ivana STETKAROVA (203 Czech Republic), Marek PETERKA (203 Czech Republic), Alena MARTINKOVA (203 Czech Republic), Pavel ŠTOURAČ (203 Czech Republic), Marketa GRUNERMELOVA (203 Czech Republic), Marta VACHOVA (203 Czech Republic), Michal DUFEK (203 Czech Republic, belonging to the institution) and Dana HORAKOVA (203 Czech Republic, guarantor)

Edition

MULTIPLE SCLEROSIS AND RELATED DISORDERS, OXFORD, ELSEVIER SCI LTD, 2023, 2211-0348

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.000 in 2022

RIV identification code

RIV/00216224:14110/23:00133288

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.msard.2023.104803

UT WoS

001024994900001

Keywords in English

Escalation strategy; Registry study; Multiple sclerosis; High-efficacy DMT

Abstract

V originále

Background: In relapsing-remitting multiple sclerosis (RRMS) the most common treatment strategy has been to start with low-moderate efficacy disease modifying therapy (LE-DMT) and to escalate to more efficacious treatments in cases of breakthrough disease activity. However, recent evidence suggests a better outcome in patients commencing with moderate-high efficacy DMT (HE-DMT) immediately after clinical onset.Objective: The aim of this study is to compare disease activity and disability outcomes in patients treated with the two alternative strategies using the Swedish and Czech national multiple sclerosis registries, taking advantage of the fact that the relative frequency of each strategy differs markedly between these two countries. Methods: Adult RRMS patients who initiated their first-ever DMT between 2013 and 2016 and were included in the Swedish MS register were compared with a similar cohort from the MS register of the Czech Republic using propensity score overlap weighting as a balancing method. The main outcomes of interest were time to confirmed disability worsening (CDW), time to achieve an expanded disability status scale (EDSS) value of 4, time to relapse, and time to confirmed disability improvement (CDI). To support the results, a sensitivity analysis focusing solely on patients from Sweden starting with HE-DMT and patients from the Czech Republic starting with LE-DMT was performed.Results: In the Swedish cohort, 42% of patients received HE-DMT as initial therapy compared to 3.8% of patients in the Czech cohort. The time to CDW was not significantly different between the Swedish and Czech cohorts (p-value 0.2764), with hazard ratio (HR) of 0.89 and a 95% confidence interval (CI) of 0.77-1.03. Patients from the Swedish cohort exhibited better outcomes for all remaining variables. The risk of reaching EDSS 4 was reduced by 26% (HR 0.74, 95%CI 0.6-0.91, p-value 0.0327), the risk of relapse was reduced by 66% (HR 0.34, 95%CI 0.3-0.39, p-value <0.001), and the probability of CDI was three times higher (HR 3.04, 95%CI 2.37-3.9, p-value <0.001).Conclusion: The analysis of the Czech and the Swedish RRMS cohorts confirmed a better prognosis for patients in Sweden, where a significant proportion of patients received HE-DMT as initial treatment.

Links

LX22NPO5107, research and development project

Name: Národní ústav pro neurologický výzkum

Investor: Ministry of Education, Youth and Sports of the CR, 5.1 EXCELES

Citovat

HRNCIAROVA, Tereza, Jiri DRAHOTA, Tim SPELMAN, Jan HILLERT, Jan LYCKE, Eva KUBALA HAVRDOVA, Eva RECMANOVA, Jana ADAMKOVA, Jan MARES, Jana LIBERTINOVA, Zbysek PAVELEK, Pavel HRADILEK, Radek AMPAPA, Ivana STETKAROVA, Marek PETERKA, Alena MARTINKOVA, Pavel ŠTOURAČ, Marketa GRUNERMELOVA, Marta VACHOVA, Michal DUFEK and Dana HORAKOVA. Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries. MULTIPLE SCLEROSIS AND RELATED DISORDERS. OXFORD: ELSEVIER SCI LTD, 2023, vol. 76, August 2023, p. 1-7. ISSN 2211-0348. Available from: https://dx.doi.org/10.1016/j.msard.2023.104803.

@article{2367141,
   author = {Hrnciarova, Tereza and Drahota, Jiri and Spelman, Tim and Hillert, Jan and Lycke, Jan and Kubala Havrdova, Eva and Recmanova, Eva and Adamkova, Jana and Mares, Jan and Libertinova, Jana and Pavelek, Zbysek and Hradilek, Pavel and Ampapa, Radek and Stetkarova, Ivana and Peterka, Marek and Martinkova, Alena and Štourač, Pavel and Grunermelova, Marketa and Vachova, Marta and Dufek, Michal and Horakova, Dana},
   article_location = {OXFORD},
   article_number = {August 2023},
   doi = {http://dx.doi.org/10.1016/j.msard.2023.104803},
   keywords = {Escalation strategy; Registry study; Multiple sclerosis; High-efficacy DMT},
   language = {eng},
   issn = {2211-0348},
   journal = {MULTIPLE SCLEROSIS AND RELATED DISORDERS},
   title = {Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries},
   url = {https://www.sciencedirect.com/science/article/pii/S221103482300305X?via%3Dihub},
   volume = {76},
   year = {2023}
}

TY  - JOUR
ID  - 2367141
AU  - Hrnciarova, Tereza - Drahota, Jiri - Spelman, Tim - Hillert, Jan - Lycke, Jan - Kubala Havrdova, Eva - Recmanova, Eva - Adamkova, Jana - Mares, Jan - Libertinova, Jana - Pavelek, Zbysek - Hradilek, Pavel - Ampapa, Radek - Stetkarova, Ivana - Peterka, Marek - Martinkova, Alena - Štourač, Pavel - Grunermelova, Marketa - Vachova, Marta - Dufek, Michal - Horakova, Dana
PY  - 2023
TI  - Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries
JF  - MULTIPLE SCLEROSIS AND RELATED DISORDERS
VL  - 76
IS  - August 2023
SP  - 1-7
EP  - 1-7
PB  - ELSEVIER SCI LTD
SN  - 22110348
KW  - Escalation strategy
KW  - Registry study
KW  - Multiple sclerosis
KW  - High-efficacy DMT
UR  - https://www.sciencedirect.com/science/article/pii/S221103482300305X?via%3Dihub
N2  - Background: In relapsing-remitting multiple sclerosis (RRMS) the most common treatment strategy has been to start with low-moderate efficacy disease modifying therapy (LE-DMT) and to escalate to more efficacious treatments in cases of breakthrough disease activity. However, recent evidence suggests a better outcome in patients commencing with moderate-high efficacy DMT (HE-DMT) immediately after clinical onset.Objective: The aim of this study is to compare disease activity and disability outcomes in patients treated with the two alternative strategies using the Swedish and Czech national multiple sclerosis registries, taking advantage of the fact that the relative frequency of each strategy differs markedly between these two countries. Methods: Adult RRMS patients who initiated their first-ever DMT between 2013 and 2016 and were included in the Swedish MS register were compared with a similar cohort from the MS register of the Czech Republic using propensity score overlap weighting as a balancing method. The main outcomes of interest were time to confirmed disability worsening (CDW), time to achieve an expanded disability status scale (EDSS) value of 4, time to relapse, and time to confirmed disability improvement (CDI). To support the results, a sensitivity analysis focusing solely on patients from Sweden starting with HE-DMT and patients from the Czech Republic starting with LE-DMT was performed.Results: In the Swedish cohort, 42% of patients received HE-DMT as initial therapy compared to 3.8% of patients in the Czech cohort. The time to CDW was not significantly different between the Swedish and Czech cohorts (p-value 0.2764), with hazard ratio (HR) of 0.89 and a 95% confidence interval (CI) of 0.77-1.03. Patients from the Swedish cohort exhibited better outcomes for all remaining variables. The risk of reaching EDSS 4 was reduced by 26% (HR 0.74, 95%CI 0.6-0.91, p-value 0.0327), the risk of relapse was reduced by 66% (HR 0.34, 95%CI 0.3-0.39, p-value <0.001), and the probability of CDI was three times higher (HR 3.04, 95%CI 2.37-3.9, p-value <0.001).Conclusion: The analysis of the Czech and the Swedish RRMS cohorts confirmed a better prognosis for patients in Sweden, where a significant proportion of patients received HE-DMT as initial treatment.
ER  -

HRNCIAROVA, Tereza, Jiri DRAHOTA, Tim SPELMAN, Jan HILLERT, Jan LYCKE, Eva KUBALA HAVRDOVA, Eva RECMANOVA, Jana ADAMKOVA, Jan MARES, Jana LIBERTINOVA, Zbysek PAVELEK, Pavel HRADILEK, Radek AMPAPA, Ivana STETKAROVA, Marek PETERKA, Alena MARTINKOVA, Pavel ŠTOURAČ, Marketa GRUNERMELOVA, Marta VACHOVA, Michal DUFEK and Dana HORAKOVA. Does initial high efficacy therapy in multiple sclerosis surpass escalation treatment strategy? A comparison of patients with relapsing-remitting multiple sclerosis in the Czech and Swedish national multiple sclerosis registries. \textit{MULTIPLE SCLEROSIS AND RELATED DISORDERS}. OXFORD: ELSEVIER SCI LTD, 2023, vol.~76, August 2023, p.~1-7. ISSN~2211-0348. Available from: https://dx.doi.org/10.1016/j.msard.2023.104803.

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