Multiple sclerosis and related disorders · 2025
Risk stratification for disease reactivation after therapy de-escalation/discontinuation in relapsing multiple sclerosis by the VIAADISC score.
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Bsteh Gabriel, Introcaso Vincenzo, Gradl Christiane, Traxler Gerhard, Barket Robert, Föttinger Fabian, Hammer Helly Noemi, Krajnc Nik, Ponleitner Markus, Zrzavy Tobias, Deisenhammer Florian, Pauli Franziska Di, Chan Andrew, Berger Thomas, Hoepner Robert, Hegen Harald
Аннотация
OBJECTIVE: To investigate whether the VIAADISC score predicts disease reactivation in relapsing multiple sclerosis (RMS) after de-escalation/discontinuation of disease-modifying-therapy (DMT) METHODS: We included RMS patients who i) received any DMT other than interferon-beta or glatiramer-acetate ≥12 months, ii) de-escalated/discontinued DMT, iii) had MRI before de-escalation/discontinuation, and iv) had ≥12 months of follow-up. VIAADISC score (0-6; age <45/45-54/≥55 = 2/1/0 points, MRI activity = 2 points, duration without clinical disease activity <4/4-8/>8 years = 2/1/0 points) was calculated. The primary endpoint was disease reactivation (relapse and/or disability progression).
RESULTS: Of 129 RMS patients included (65.1 % females), 44.2 % had received natalizumab (NTZ), 19.4 % dimethylfumarate (DMF), 17.1 % teriflunomide (TERI), 14.0 % fingolimod (FTY) and 5.4 % rituximab (RTX). At de-escalation/discontinuation, mean age was 44.3 years (12.3), median duration of clinical stability 2.4 years (IQR1.5-3.9) and 93.1 % were without MRI activity, resulting in median VIAADISC score of 3 (IQR 2-4). Over median 6.0 years, disease reactivation reoccurred in 55.0 %, most frequently after NTZ/FTY discontinuation (73.3 %). In Cox regression, risk of disease reactivation was independently predicted by higher VIAADISC scores (HR 1.25 per point [95 % CI 1.03-1.53], p = 0.028) and de-escalation from FTY/NTZ (HR 2.20 [CI 1.18-4.10], p = 0.013). No disease reactivation was observed when DMF/TERI were discontinued with VIAADISC <2.
INTERPRETATION: Risk of disease reactivation after discontinuation from DMF/TERI can be stratified with the VIAADISC score and appears to be safe above age 45-55 and with long-lasting stability. However, risk after de-escalation from NTZ/FTY is too high to allow reliable stratification and should be avoided by lateral switch.
RESULTS: Of 129 RMS patients included (65.1 % females), 44.2 % had received natalizumab (NTZ), 19.4 % dimethylfumarate (DMF), 17.1 % teriflunomide (TERI), 14.0 % fingolimod (FTY) and 5.4 % rituximab (RTX). At de-escalation/discontinuation, mean age was 44.3 years (12.3), median duration of clinical stability 2.4 years (IQR1.5-3.9) and 93.1 % were without MRI activity, resulting in median VIAADISC score of 3 (IQR 2-4). Over median 6.0 years, disease reactivation reoccurred in 55.0 %, most frequently after NTZ/FTY discontinuation (73.3 %). In Cox regression, risk of disease reactivation was independently predicted by higher VIAADISC scores (HR 1.25 per point [95 % CI 1.03-1.53], p = 0.028) and de-escalation from FTY/NTZ (HR 2.20 [CI 1.18-4.10], p = 0.013). No disease reactivation was observed when DMF/TERI were discontinued with VIAADISC <2.
INTERPRETATION: Risk of disease reactivation after discontinuation from DMF/TERI can be stratified with the VIAADISC score and appears to be safe above age 45-55 and with long-lasting stability. However, risk after de-escalation from NTZ/FTY is too high to allow reliable stratification and should be avoided by lateral switch.