Article detail · 2020
Effect of Disease-Modifying Therapy on Disability in Relapsing-Remitting Multiple Sclerosis Over 15 Years
- Year
- 2020
- Type
- article
Data source split
- YÖKSİS YÖKSİS article record
- YÖKSİS venue Neurology
- Catalog match (ISSN) Neurology
- OpenAlex OpenAlex enrichment (abstract, citations, topics)
Abstract
OpenAlex · English
Objective To test the hypothesis that immunotherapy prevents long-term disability in relapsing-remitting multiple sclerosis (MS), we modeled disability outcomes in 14,717 patients. Methods We studied patients from MSBase followed for ≥1 year, with ≥3 visits, ≥1 visit per year, and exposed to MS therapy, and a subset of patients with ≥15-year follow-up. Marginal structural models were used to compare the cumulative hazards of 12-month confirmed increase and decrease in disability, Expanded Disability Status Scale (EDSS) step 6, and the incidence of relapses between treated and untreated periods. Marginal structural models were continuously readjusted for patient age, sex, pregnancy, date, disease course, time from first symptom, prior relapse history, disability, and MRI activity. Results A total of 14,717 patients were studied. During the treated periods, patients were less likely to experience relapses (hazard ratio 0.60, 95% confidence interval [CI] 0.43–0.82, p = 0.0016), worsening of disability (0.56, 0.38–0.82, p = 0.0026), and progress to EDSS step 6 (0.33, 0.19–0.59, p = 0.00019). Among 1,085 patients with ≥15-year follow-up, the treated patients were less likely to experience relapses (0.59, 0.50–0.70, p = 10−9) and worsening of disability (0.81, 0.67–0.99, p = 0.043). Conclusion Continued treatment with MS immunotherapies reduces disability accrual by 19%–44% (95% CI 1%–62%), the risk of need of a walking aid by 67% (95% CI 41%–81%), and the frequency of relapses by 40–41% (95% CI 18%–57%) over 15 years. This study provides evidence that disease-modifying therapies are effective in improving disability outcomes in relapsing-remitting MS over the long term. Classification of Evidence This study provides Class IV evidence that, for patients with relapsing-remitting MS, long-term exposure to immunotherapy prevents neurologic disability.
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100 citations
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11 publications in the local catalog that cite this work (OpenAlex reference match; not the full global list).
- Variability of the response to immunotherapy among subgroups of patients with multiple sclerosis 2023
- Disability accrual in primary and secondary progressive multiple sclerosis 2023
- Comparative effectiveness in multiple sclerosis: A methodological comparison. 2023
- Variability of the response to immunotherapy among subgroups of patients with multiple sclerosis 2023
- Comparative effectiveness in multiple sclerosis: A methodological comparison 2023
- Impact of methodological choices in comparative effectiveness studies: application in natalizumab versus fingolimod comparison among patients with multiple sclerosis 2022
- mRNA versus inactivated virus COVID-19 vaccines in multiple sclerosis: Humoral responses and protectivity—Does it matter? 2023
- Neurological manifestations and etiological risk factors in patients hospitalized with COVID-19 in Turkey 2022
- External validation of a clinical prediction model in multiple sclerosis 2022
- Preserving Neurological Function in People at High and Low Risk of Aggressive Multiple Sclerosis: An Observational Cohort Study 2026