Effectiveness of Disease-Modifying Treatment on Spinal Cord Lesion Formation in Relapse-Onset Multiple Sclerosis: An MSBase Registry Study.

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-11-01 Epub Date: 2024-09-06 DOI:10.1007/s40263-024-01115-x
Daniel Kreiter, Tomas Kalincik, Raymond Hupperts, Francesco Patti, Daniele Spitaleri, Matteo Foschi, Andrea Surcinelli, Davide Maimone, Bassem Yamout, Samia J Khoury, Jeannette Lechner-Scott, Serkan Ozakbas, Oliver Gerlach
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Abstract

Background: Spinal cord lesions in multiple sclerosis (MS) have considerable impact on disability. High-efficacy disease-modifying treatments (hDMTs) are associated with greater reduction of relapses and new brain lesions compared to low-efficacy treatments (lDMTs). Knowledge on the impact of DMTs on cord lesion formation is limited as these outcome measures were not included in MS treatment trials. This study aims to investigate whether hDMTs reduce the formation of cord lesions more effectively than lDMTs.

Methods: Patients with relapse-onset MS, a cord magnetic resonance imaging (MRI) within 6 months before/after initiation of their first DMT and ≥1 cord MRI at follow-up (interval > 6 months) were extracted from the MSBase registry (ACTRN12605000455662). Patients treated with hDMTs ≥90% or lDMTs ≥90% of follow-up duration were considered the hDMT and lDMT groups, respectively. Matching was performed using propensity scores. Cox proportional hazards models were used to estimate the hazards of new cord lesions, brain lesions and relapses.

Results: Ninety-four and 783 satisfied hDMT and lDMT group criteria, respectively. Seventy-seven hDMT patients were matched to 184 lDMT patients. In the hDMT group there was no evidence of reduction of new cord lesions (hazard ratio [HR] 0.99 [95% CI 0.51, 1.92], p = 0.97), while there were fewer new brain lesions (HR 0.22 [95% CI 0.10, 0.49], p < 0.001) and fewer relapses (HR 0.45 [95% CI 0.28, 0.72], p = 0.004).

Conclusion: A potential discrepancy exists in the effect of hDMTs over lDMTs in preventing spinal cord lesions versus brain lesions and relapses. While hDMTs provided a significant reduction for the latter when compared to lDMTs, there was no significant reduction in new spinal cord lesions.

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疾病调整治疗对复发型多发性硬化症脊髓病变形成的影响:MSBase 登记研究
背景:多发性硬化症(MS)的脊髓病变对残疾有很大影响。与低效治疗(lDMTs)相比,高效改变病情治疗(hDMTs)能更有效地减少复发和脑部新病变。由于多发性硬化症治疗试验未包括这些结果测量,因此有关DMTs对脊髓病变形成的影响的知识十分有限。本研究旨在探讨hDMTs是否比lDMTs更有效地减少脊髓病变的形成:方法:从 MSBase 注册表(ACTRN12605000455662)中抽取复发多发性硬化症患者,这些患者在首次使用 DMT 之前/之后的 6 个月内进行过一次脊髓磁共振成像(MRI),并且在随访期间(间隔时间大于 6 个月)进行过≥1 次脊髓磁共振成像。随访时间内接受hDMT治疗≥90%或接受lDMT治疗≥90%的患者分别被视为hDMT组和lDMT组。采用倾向评分进行匹配。采用 Cox 比例危险度模型估算新的脊髓病变、脑部病变和复发的危险度:分别有94人和783人符合hDMT组和lDMT组标准。77名hDMT患者与184名lDMT患者进行了配对。在 hDMT 组中,没有证据表明新的脊髓病变减少(危险比 [HR] 0.99 [95% CI 0.51, 1.92],p = 0.97),而新的脑部病变减少(HR 0.22 [95% CI 0.10, 0.49],p < 0.001),复发减少(HR 0.45 [95% CI 0.28, 0.72],p = 0.004):在预防脊髓病变与脑损伤和复发方面,hDMTs与lDMTs的效果可能存在差异。虽然 hDMTs 比 lDMTs 能显著减少脑损伤和复发,但却不能显著减少新的脊髓病变。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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