Initial high-efficacy disease-modifying therapy in multiple sclerosis: A nationwide cohort study

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  • Mathias Due Buron, Rigshospitalet
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  • Thor Ameri Chalmer, Rigshospitalet
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  • Finn Sellebjerg, Rigshospitalet
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  • Ismael Barzinji, Aalborg University
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  • Jeppe Romme Christensen, Rigshospitalet
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  • Mette Kirstine Christensen, Aarhus University
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  • Victoria Hansen, Aalborg University
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  • Zsolt Illes, Odense University Hospital
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  • Henrik Boye Jensen, Lillebaelt Hospital
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  • Matthias Kant, Hospital of Southern Jutland, Sønderborg
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  • Viktoria Papp, Odense University Hospital
  • ,
  • Thor Petersen
  • Peter Vestergaard Rasmussen
  • Jakob Schäfer, Aalborg University
  • ,
  • Ásta Theódórsdóttir, Odense University Hospital
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  • Arkadiusz Weglewski, Herlev Hospital, Herlev, Denmark.
  • ,
  • Per Soelberg Sorensen, Rigshospitalet
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  • Melinda Magyari, Rigshospitalet

OBJECTIVE: To determine the effectiveness of high-efficacy disease-modifying therapies (heDMTs) vs medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naive patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry. METHODS: We identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity score matched sample of patients starting meDMT. RESULTS: We included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval [CI] 10.4%-23.0%) and 30.1% (95% CI 23.1%-37.1%) for heDMT and meDMT initiators, respectively (hazard ratio [HR] 0.53, 95% CI 0.33-0.83, p = 0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37-0.67). Results were similar after pairwise censoring and in subgroups with high baseline activity, diagnosis after 2006, or information on baseline T2 lesion load. CONCLUSION: We found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.

Original languageEnglish
JournalNeurology
Volume95
Issue8
Pages (from-to)e1041-e1051
ISSN0028-3878
DOIs
Publication statusPublished - Aug 2020

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