Improving the decision to switch from first- to second-line therapy in multiple sclerosis: A dynamic scoring system. (February 2023)

• Record Type: Journal Article
• Authors: Sabathé, Camille; Casey, Romain; Vukusic, Sandra; Leray, Emmanuelle; Mathey, Guillaume; De Sèze, Jérôme; Ciron, Jonathan; Wiertlewski, Sandrine; Ruet, Aurélie; Pelletier, Jean; Zéphir, Hélène; Michel, Laure; Lebrun-Frenay, Christine; Moisset, Xavier; Thouvenot, Eric; Camdessanché, Jean-Philippe; Bakchine, Serge; Stankoff, Bruno; Al Khedr, Abdullatif; Cabre, Philippe; Maillart, Elisabeth; Berger, Eric; Heinzlef, Olivier; Hankiewicz, Karolina; Moreau, Thibault; Gout, Olivier; Bourre, Bertrand; Wahab, Abir; Labauge, Pierre; Montcuquet, Alexis; Defer, Gilles; Maurousset, Aude; Maubeuge, Nicolas; Dimitri Boulos, Dalia; Ben Nasr, Haïfa; Nifle, Chantal; Casez, Olivier; Laplaud, David-Axel; Foucher, Yohann;
• Is Part Of: Multiple sclerosis. Volume 29:Number 2(2023)
• Page Start: 236
• Page End: 247
• Publication Date: 2023-02
• Subjects: Epidemiology -- multiple sclerosis -- second-line treatment -- treatment response; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585221139156
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: In relapsing-remitting multiple sclerosis (RRMS), early identification of suboptimal responders can prevent disability progression. Objective: We aimed to develop and validate a dynamic score to guide the early decision to switch from first- to second-line therapy. Methods: Using time-dependent propensity scores (PS) from a French cohort of 12, 823 patients with RRMS, we constructed one training and two validation PS-matched cohorts to compare the switched patients to second-line treatment and the maintained patients. We used a frailty Cox model for predicting individual hazard ratios (iHRs). Results: From the validation PS-matched cohort of 348 independent patients with iHR ⩽ 0.69, we reported the 5-year relapse-free survival at 0.14 (95% confidence interval (CI) 0.09–0.22) for the waiting group and 0.40 (95% CI 0.32–0.51) for the switched group. From the validation PS-matched cohort of 518 independent patients with iHR > 0.69, these values were 0.37 (95% CI 0.30–0.46) and 0.44 (95% CI 0.37–0.52), respectively. Conclusions: By using the proposed dynamic score, we estimated that at least one-third of patients could benefit from an earlier switch to prevent relapse.