https://doi.org/10.55788/428b9f6f
A retrospective, multicentre study compared the time to onset of focal inflammatory activity (clinical flare and/or MRI activity) in 2 matched groups of elderly patients with MS who either continued or discontinued HET [1]. Data was extracted from the Observatoire Français de la Sclérose en Plaques (OFSEP) database.
Included were 1,620 participants ≥50 years of age (mean age 58 years) who had relapsing-remitting MS or secondary progressive MS that had been inactive for ≥2 years. Their median Expanded Disability Status Scale (EDSS) score was 4.5, and the median time of disease stability was 4.4 years. Participants were classified into 2 groups: discontinuation (n=1,452) and continuation (n=168); 154 participants in each group were matched via an innovative dynamic propensity score. Time to first relapse, time to first MRI activity, annualised relapse rate (ARR) at 1 and 2 years, and disability progression at 1, 2, and 5 years were compared.
There was a significantly higher risk of increased inflammatory activity in the discontinuation group versus the continuation group. The hazard ratio for the time to first clinical activity after matching was 3.6 (95% CI 2.0–6.5; Plog-rank<0.001). The risk of relapse within 1 year differed according to the type of HET that was discontinued: 33.6% for natalizumab, 16.3% for fingolimod, and 0.0% for anti-CD20 (rituximab or ocrelizumab). Treatment was consequently resumed in 75.6% of natalizumab users, 43.1% of fingolimod users, and 22.4% of anti-CD20 users. Age remained the main protective factor against clinical or MRI activity in the discontinuation group (P=0.044). There was a linear decrease in the risk of inflammatory activity after the age of 50 (-7% per year).
- Collongues N, et al. Comparison of high efficacy treatment discontinuation and continuation among stable multiple sclerosis patients after 50. Abstract O129, ECTRIMS 2024, 18–20 September, Copenhagen, Denmark.
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Table of Contents: ECTRIMS 2024
Featured articles
Diagnosis, Biomarkers, and Phenotypes
Revised McDonald criteria allow earlier and more precise MS diagnosis
Approaches to RIS and MS converge
AI versus clinicians: who diagnoses MS faster and better?
Blood markers predict MS progression
Gut microbiota modulate inflammation and cortical damage
Risk factors and importance of persistent PIRA
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Treatment: Strategies
Encouraging real-world results of AHSCT to treat aggressive MS
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B cell-tailored dosing of ocrelizumab shows good results
First-line moderate-efficacy DMTs show similar efficacy
Treatment: Trials
Tolebrutinib slows disability worsening in relapsing MS
Frexalimab shows favourable safety and efficacy in OLE
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Tolebrutinib slows disability in non-relapsing SPMS
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Comorbidity Risks and Pregnancy
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More comorbidity is associated with worse clinical outcomes in MS
Transfer of ocrelizumab into breastmilk is negligible
NMOSD/MOGAD
Ineffective response to EBV in MS not seen in similar diseases
Comparative effectiveness and safety of DMTs in NMOSD
Age, time, and treatment determine relapse risk in MOGAD
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