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Anti‐inflammatory disease‐modifying treatment and disability progression in primary progressive multiple sclerosis: a cohort study
Author(s) -
Lorscheider J.,
Kuhle J.,
Izquierdo G.,
Lugaresi A.,
Havrdova E.,
Horakova D.,
Hupperts R.,
Duquette P.,
Girard M.,
Prat A.,
Grand'Maison F.,
Grammond P.,
Sola P.,
Ferraro D.,
Trojano M.,
RamoTello C.,
LechnerScott J.,
Pucci E.,
Solaro C.,
Slee M.,
Van Pesch V.,
Sanchez Menoyo J. L.,
Walt A.,
Butzkueven H.,
Kappos L.,
Kalincik T.
Publication year - 2019
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13824
Subject(s) - medicine , expanded disability status scale , hazard ratio , ocrelizumab , multiple sclerosis , propensity score matching , confidence interval , proportional hazards model , observational study , physical therapy , immunology , rituximab , lymphoma
Background and purpose Treatment options in primary progressive multiple sclerosis ( PPMS ) are scarce and, with the exception of ocrelizumab, anti‐inflammatory agents have failed to show efficacy in ameliorating disability progression. The aim of this study was to investigate a potential effect of anti‐inflammatory disease‐modifying treatment on disability outcomes in PPMS . Methods Using MSB ase, a large, international, observational database, we identified patients with PPMS who were either never treated or treated with a disease‐modifying agent. Propensity score matching was used to select subpopulations with similar baseline characteristics. Expanded Disability Status Scale ( EDSS ) outcomes were compared with an intention‐to‐treat and an as‐treated approach in paired, pairwise‐censored analyses. Results Of the 1284 included patients, 533 were matched (treated, n = 195; untreated n = 338). Median on‐study pairwise‐censored follow‐up was 3.4 years (quartiles 1.2–5.5). No difference in the hazard of experiencing 3‐month confirmed EDSS progression events was observed between the groups [hazard ratio ( HR ), 1.0; 95% confidence interval ( CI ), 0.6–1.7, P = 0.87]. We did not find significant differences in the hazards of confirmed EDSS improvement ( HR , 1.0; 95% CI , 0.6–1.6, P = 0.91) or reaching a confirmed EDSS step ≥7 ( HR , 1.1; 95% CI , 0.7–1.6, P = 0.69). Conclusion Our pooled analysis of disease‐modifying agents suggests that these therapies have no substantial effect on short‐ to medium‐term disability outcomes in PPMS .