Highlights
- •Patient's age is the most important factor in DMTs choice
- •Choice of oral drugs vs self-injectables ones is driven by unfavorable prognostic factors
- •Natalizumab preferred in early stage of severe disease and in younger patients
Abstract
Background
The approval of an increasing number of disease modifying drugs for the treatment
of Multiple Sclerosis (MS) creates new challenges for patients and clinicians on the
first treatment choice. The main aim of this study was to assess factors impacting
first therapy choice in a large Italian MS cohort.
Methods
Newly diagnosed relapsing-remitting (RR) MS patients (2010-2018) followed in 24 Italian
MS centres were included in the study. We evaluated the association of baseline demographics,
clinical and MRI characteristics to the first treatment choice by logistic regression
models applied to pre-defined binary alternatives: dimethyl fumarate vs injectables
(interferon and glatiramer acetate), teriflunomide vs injectables, fingolimod vs dimethyl
fumarate and fingolimod vs natalizumab.
Results
We enrolled 3025 patients in the period between January 2010 and June 2018. Relapses
in the previous year (OR = 2.75; p = 0.001), presence of spinal cord lesions (OR = 1.80; p = 0.002) and higher number (>9) of T2 lesions on the baseline brain MRI scan (OR = 1.65; p = 0.022) were the factors associated to dimethyl fumarate choice as first therapy
vs an injectable drug. Older age (OR = 1.06; p < 0.001), male sex (OR = 2.29; p = 0.001) and higher EDSS (OR = 1.36; p < 0.001) were the factors associated with the choice of teriflunomide vs injectables.
In more recent years, dimethyl fumarate (OR = 3.23; p < 0.001) and teriflunomide (OR = 2.53; p < 0.001) were chosen more frequently than injectables therapies. The main determinant
for the choice of fingolimod as compared with dimethyl fumarate was a higher EDSS
(OR = 1.56; p = 0.001), while there was a weak association with a longer disease duration (p = 0.068) and a longer time from onset to diagnosis (p = 0.085). Compared to fingolimod, natalizumab was preferred in patients with a younger
age (OR = 0.95; p = 0.003) and higher EDSS (OR = 1.45; p = 0.007) and a shorter disease duration (OR = 0.52; p = 0.076).
Conclusion
Many factors guided therapeutic decision for our Italian cohort of MS patients; they
are mainly related to MS disease activity, baseline EDSS, disease duration and age.
Keywords
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Article info
Publication history
Published online: March 17, 2020
Accepted:
March 15,
2020
Received in revised form:
March 13,
2020
Received:
December 16,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
