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Country, Sex, EDSS Change and Therapy Choice Independently Predict Treatment Discontinuation in Multiple Sclerosis and Clinically Isolated Syndrome

2012; Public Library of Science; Volume: 7; Issue: 6 Linguagem: Inglês

10.1371/journal.pone.0038661

1932-6203

Claire Meyniel, Timothy Spelman, Vilija Jokubaitis, Maria Trojano, Guillermo Izquierdo, François Grand’Maison, Celia Oreja‐Guevara, Cavit Boz, Alessandra Lugaresi, Marc Girard, Pierre Grammond, Gerardo Iuliano, Marcela Fiol, José Antonio Cabrera-Gómez, Ricardo Fernández‐Bolaños, Giorgio Giuliani, Jeannette Lechner‐Scott, Edgardo Cristiano, Joseph Herbert, Tatjana Petkovska‐Boskova, Roberto Bergamaschi, Vincent Van Pesch, Fraser Moore, Norbert Vella, Mark Slee, Vetere Santiago, Michael Barnett, Eva Havrdová, Carolyn Young, Carmen Adella Sîrbu, Mary Tanner, Michelle Rutherford, Helmut Butzkueven,

Rheumatoid Arthritis Research and Therapies

Objectives We conducted a prospective study, MSBASIS, to assess factors leading to first treatment discontinuation in patients with a clinically isolated syndrome (CIS) and early relapsing-remitting multiple sclerosis (RRMS). Methods The MSBASIS Study, conducted by MSBase Study Group members, enrols patients seen from CIS onset, reporting baseline demographics, cerebral magnetic resonance imaging (MRI) features and Expanded Disability Status Scale (EDSS) scores. Follow-up visits report relapses, EDSS scores, and the start and end dates of MS-specific therapies. We performed a multivariable survival analysis to determine factors within this dataset that predict first treatment discontinuation. Results A total of 2314 CIS patients from 44 centres were followed for a median of 2.7 years, during which time 1247 commenced immunomodulatory drug (IMD) treatment. Ninety percent initiated IMD after a diagnosis of MS was confirmed, and 10% while still in CIS status. Over 40% of these patients stopped their first IMD during the observation period. Females were more likely to cease medication than males (HR 1.36, p = 0.003). Patients treated in Australia were twice as likely to cease their first IMD than patients treated in Spain (HR 1.98, p = 0.001). Increasing EDSS was associated with higher rate of IMD cessation (HR 1.21 per EDSS unit, p<0.001), and intramuscular interferon-β-1a (HR 1.38, p = 0.028) and subcutaneous interferon-β-1a (HR 1.45, p = 0.012) had higher rates of discontinuation than glatiramer acetate, although this varied widely in different countries. Onset cerebral MRI features, age, time to treatment initiation or relapse on treatment were not associated with IMD cessation. Conclusion In this multivariable survival analysis, female sex, country of residence, EDSS change and IMD choice independently predicted time to first IMD cessation.