Patients with multiple sclerosis on long-term injectable therapies may suffer from the so-called "needle fatigue", i.e., a waning commitment to continue with the prescribed injectable treatment. Therefore, alternative treatment strategies to enhance patients' adherence are warranted. In this independent, multicentre post-marketing study, we sought to directly compare switching to either teriflunomide (TFN), dimethyl fumarate (DMF), or pegylated interferon (PEG) on treatment persistence and time to first relapse over a 12-month follow-up. We analyzed a total of 621 patients who were free of relapses and gadolinium-enhancing lesions in the year prior to switching to DMF (n = 265), TFN (n = 160), or PEG (n = 196). Time to discontinuation and time to first relapse were explored in the whole population by Cox regression models adjusted for baseline variables and after a 1:1:1 ratio propensity score (PS)-based matching procedure. Treatment discontinuation was more frequent after switching to PEG (28.6%) than DMF (14.7%; hazard ratio [HR] = 0.25, p < 0.001) and TFN (16.9%; HR = 0.27, p < 0.001). We found similar results even in the re-sampled cohort of 222 patients (74 per group) derived by the PS-based matching procedure. The highest discontinuation rate observed in PEG recipient was mainly due to poor tolerability (p = 0.005) and pregnancy planning (p = 0.04). The low number of patients who relapsed over the 12-month follow-up (25 out of 621, approximately 4%) prevented any analysis on the short-term risk of relapse. This real-world study suggests that oral drugs are a better switching option than low-frequency interferon for promoting the short-term treatment persistence in stable patients who do not tolerate injectable drugs.

Prosperini, L., Cortese, A., Lucchini, M., Boffa, L., Borriello, G., Buscarinu, M.c., et al. (2020). Exit strategies for “needle fatigue” in multiple sclerosis: a propensity score-matched comparison study. JOURNAL OF NEUROLOGY, 267(3), 694-702 [10.1007/s00415-019-09625-1].

Exit strategies for “needle fatigue” in multiple sclerosis: a propensity score-matched comparison study

Centonze D.;Landi D.;Marfia G.;Mataluni G.;Monteleone F.;Zannino S.;
2020-01-01

Abstract

Patients with multiple sclerosis on long-term injectable therapies may suffer from the so-called "needle fatigue", i.e., a waning commitment to continue with the prescribed injectable treatment. Therefore, alternative treatment strategies to enhance patients' adherence are warranted. In this independent, multicentre post-marketing study, we sought to directly compare switching to either teriflunomide (TFN), dimethyl fumarate (DMF), or pegylated interferon (PEG) on treatment persistence and time to first relapse over a 12-month follow-up. We analyzed a total of 621 patients who were free of relapses and gadolinium-enhancing lesions in the year prior to switching to DMF (n = 265), TFN (n = 160), or PEG (n = 196). Time to discontinuation and time to first relapse were explored in the whole population by Cox regression models adjusted for baseline variables and after a 1:1:1 ratio propensity score (PS)-based matching procedure. Treatment discontinuation was more frequent after switching to PEG (28.6%) than DMF (14.7%; hazard ratio [HR] = 0.25, p < 0.001) and TFN (16.9%; HR = 0.27, p < 0.001). We found similar results even in the re-sampled cohort of 222 patients (74 per group) derived by the PS-based matching procedure. The highest discontinuation rate observed in PEG recipient was mainly due to poor tolerability (p = 0.005) and pregnancy planning (p = 0.04). The low number of patients who relapsed over the 12-month follow-up (25 out of 621, approximately 4%) prevented any analysis on the short-term risk of relapse. This real-world study suggests that oral drugs are a better switching option than low-frequency interferon for promoting the short-term treatment persistence in stable patients who do not tolerate injectable drugs.
2020
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/26 - NEUROLOGIA
English
Con Impact Factor ISI
Multiple sclerosis; Needle fatigue; Oral drugs; Treatment persistence
https://link.springer.com/article/10.1007/s00415-019-09625-1
Prosperini, L., Cortese, A., Lucchini, M., Boffa, L., Borriello, G., Buscarinu, M.c., et al. (2020). Exit strategies for “needle fatigue” in multiple sclerosis: a propensity score-matched comparison study. JOURNAL OF NEUROLOGY, 267(3), 694-702 [10.1007/s00415-019-09625-1].
Prosperini, L; Cortese, A; Lucchini, M; Boffa, L; Borriello, G; Buscarinu, Mc; Capone, F; Centonze, D; De Fino, C; De Pascalis, D; Fantozzi, R; Ferraro, E; Filippi, M; Galgani, S; Gasperini, C; Haggiag, S; Landi, D; Marfia, G; Mataluni, G; Millefiorini, E; Mirabella, M; Monteleone, F; Nociti, V; Pontecorvo, S; Romano, S; Ruggieri, S; Salvetti, M; Tortorella, C; Zannino, S; Di Battista, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/239536
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