Disease-modifying treatment and disability progression in subclasses of patients with primary progressive MS: results from the Big MS Data Network.
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Lorscheider Johannes, Signori Alessio, Subramaniam Suvitha, Benkert Pascal, Vukusic Sandra, Trojano Maria, Hillert Jan, Glaser Anna, Hyde Robert, Spelman Tim, Magyari Melinda, Elberling Frederik, Pontieri Luigi, Koch-Henriksen Nils, Sørensen Per Soelberg, Gerlach Oliver, Prat Alexandre, Girard Marc, Eichau Sara, Grammond Pierre, Horakova Dana, Ramo-Tello Cristina, Roos Izanne, Buzzard Katherine, Lechner Scott Jeanette, Sánchez-Menoyo José Luis, Alroughani Raed, Prévost Julie, Kuhle Jens, Gray Orla, Mathey Guillaume, Michel Laure, Ciron Jonathan, De Sèze Jérôme, Maillart Elisabeth, Ruet Aurelie, Labauge Pierre, Zephir Helene, Kwiatkowski Arnaud, van der Walt Anneke, Kalincik Tomas, Butzkueven Helmut, Italian MS Register, Observatoire Français de la Sclérose en Plaques (OFSEP), MSBase Study Group, Swedish MS Registry, Big MS Data Network
Аннотация
METHODS: Within the framework of the Big MS Data network, we merged data from the Observatoire Français de la Sclérose en Plaques, the Swedish and Italian MS registries, and MSBase. We identified patients with PPMS that started DMT or were never treated during the observed period. Subpopulations with comparable baseline characteristics were selected by propensity score matching. Disability outcomes were analysed in time-to-recurrent event analyses, which were repeated in subclasses with different disability trajectories determined by latent class mixed models.
RESULTS: Of the 3243 included patients, we matched 739 treated and 1330 untreated patients with a median follow-up of 3 years after pairwise censoring. No difference in the risk of confirmed disability worsening (CDW) was observed between the groups in the fully matched dataset (HR 1.11, 95% CI 0.97 to 1.23, p=0.127). However, we found a lower risk for CDW among the class of treated patients with an aggressive disability trajectory (n=360, HR 0.68, 95% CI 0.50 to 0.92, p=0.014).
CONCLUSIONS: In line with previous studies, our data suggest that DMT does not ameliorate disability worsening in PPMS, in general. However, we observed a beneficial effect of DMT on disability worsening in patients with aggressive predicted disability trajectories.