1. Disease-modifying drugs can reduce disability progression in relapsing multiple sclerosis
- Author
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Rocco Totaro, Umberto Aguglia, Pietro Iaffaldano, Ciro Florio, Giuseppe Salemi, Giacomo Lus, Giovanna De Luca, Maurizia Gatto, Emilio Portaccio, Francesco Ottavio Logullo, Marta Simone, Angelo Ghezzi, Eleonora Cocco, Carlo Pozzilli, Simonetta Galgani, Matilde Inglese, Francesco Patti, Enrico Millefiorini, Giuseppe Lucisano, Giancarlo Di Battista, Roberto Bergamaschi, Maria Trojano, Franco Granella, Maria Pia Amato, Patrizia Sola, M. Vianello, Laura Tudisco, Roberto Fratangelo, Lorenzo Razzolini, Giancarlo Comi, Mattia Fonderico, Elio Prestipino, Angelo Bellinvia, Luisa Pastò, Mauro Zaffaroni, Marco Salvetti, Vincenzo Brescia Morra, Amato, Maria Pia, Fonderico, Mattia, Portaccio, Emilio, Pastò, Luisa, Razzolini, Lorenzo, Prestipino, Elio, Bellinvia, Angelo, Tudisco, Laura, Fratangelo, Roberto, Comi, Giancarlo, Patti, Francesco, De Luca, Giovanna, Brescia Morra, Vincenzo, Cocco, Eleonora, Pozzilli, Carlo, Sola, Patrizia, Bergamaschi, Roberto, Salemi, Giuseppe, Inglese, Matilde, Millefiorini, Enrico, Galgani, Simonetta, Zaffaroni, Mauro, Ghezzi, Angelo, Salvetti, Marco, Lus, Giacomo, Florio, Ciro, Totaro, Rocco, Granella, Franco, Vianello, Marika, Gatto, Maurizia, Di Battista, Giancarlo, Aguglia, Umberto, Logullo, Francesco Ottavio, Simone, Marta, Lucisano, Giuseppe, Iaffaldano, Pietro, and Trojano, Maria
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Adult ,Male ,medicine.medical_specialty ,neuroinflammation ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Multiple Sclerosis, Relapsing-Remitting ,Internal medicine ,medicine ,Humans ,Disabled Persons ,030212 general & internal medicine ,Prospective Studies ,Risk factor ,clinical trials ,clinically isolated syndrome ,demyelination ,multiple sclerosis epidemiology ,Retrospective Studies ,Clinically isolated syndrome ,Expanded Disability Status Scale ,Proportional hazards model ,business.industry ,Hazard ratio ,Middle Aged ,Italy ,Antirheumatic Agents ,Cohort ,Disease Progression ,Settore MED/26 - Neurologia ,Female ,Neurology (clinical) ,Age of onset ,business ,030217 neurology & neurosurgery ,Cohort study ,Follow-Up Studies - Abstract
An ever-expanding number of disease-modifying drugs for multiple sclerosis have become available in recent years, after demonstrating efficacy in clinical trials. In the real-world setting, however, disease-modifying drugs are prescribed in patient populations that differ from those included in pivotal studies, where extreme age patients are usually excluded or under-represented. In this multicentre, observational, retrospective Italian cohort study, we evaluated treatment exposure in three cohorts of patients with relapsing-remitting multiple sclerosis defined by age at onset: paediatric-onset (≤18 years), adult-onset (18–49 years) and late-onset multiple sclerosis (≥50 years). We included patients with a relapsing-remitting phenotype, ≥5 years follow-up, ≥3 Expanded Disability Status Scale (EDSS) evaluations and a first neurological evaluation within 3 years from the first demyelinating event. Multivariate Cox regression models (adjusted hazard ratio with 95% confidence intervals) were used to assess the risk of reaching a first 12-month confirmed disability worsening and the risk of reaching a sustained EDSS of 4.0. The effect of disease-modifying drugs was assessed as quartiles of time exposure. We found that disease-modifying drugs reduced the risk of 12-month confirmed disability worsening, with a progressive risk reduction in different quartiles of exposure in paediatric-onset and adult-onset patients [adjusted hazard ratios in non-exposed versus exposed >62% of the follow-up time: 8.0 (3.5–17.9) for paediatric-onset and 6.3 (4.9–8.0) for adult-onset, P
- Published
- 2020