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Quantifying the risk of disease reactivation after interferon and glatiramer acetate discontinuation in multiple sclerosis: The VIAADISC score
Author(s) -
Bsteh Gabriel,
Hegen Harald,
Riedl Katharina,
Altmann Patrick,
Auer Michael,
Berek Klaus,
Di Pauli Franziska,
Ehling Rainer,
Kornek Barbara,
Monschein Tobias,
Rinner Walter,
Schmied Christiane,
Wurth Sebastian,
Zebenholzer Karin,
Zinganell Anne,
Zrzavy Tobias,
Zulehner Gudrun,
Deisenhammer Florian,
Rommer Paulus,
Leutmezer Fritz,
Berger Thomas
Publication year - 2021
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.14705
Subject(s) - discontinuation , glatiramer acetate , medicine , multiple sclerosis , observational study , disease , magnetic resonance imaging , interferon beta , immunology , radiology
Background and purpose There is a lack of evidence guiding discontinuation of disease‐modifying therapy (DMT) in relapsing multiple sclerosis (RMS). Thus, the objective of this study was to generate and validate a risk score for disease reactivation after DMT discontinuation in RMS. Methods We drew a generation and validation dataset from two separate prospectively collected observational databases including RMS patients who received interferon‐β or glatiramer acetate for ≥12 months, then discontinued DMT for ≥6 months and had ≥2 years of follow‐up available. In the generation sample ( n = 168), regression analysis was performed to identify clinical or magnetic resonance imaging (MRI) variables independently predicting disease reactivation after DMT discontinuation. A predictive score was calculated using the variables included in the multivariable model and applied to the validation sample ( n = 98). Results The variables included in the final model as independent predictors of disease reactivation were age at discontinuation, MRI activity at discontinuation, and duration of clinical stability (all p < 0.001). The resulting score was able to robustly identify patients at high (83%–85%), moderate (36%–38%), and low risk (7%) of disease reactivation within 5 years after DMT discontinuation in both cohorts. Conclusions The composite VIAADISC score is a valuable tool to inform and support patients and neurologists in the process of decision making to discontinue injectable DMTs.