Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis
Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis
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DOI：
10.1001/jama.2018.20588
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发表时间：
2019-01-15
影响因子：
120.7
通讯作者：
Zwanikken, Cees
中科院分区：
文献类型：
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作者：
Brown, J. William L.;Coles, Alasdair;Zwanikken, Cees
重要性在发病20年内，80%的复发-缓解型多发性硬化症(MS)未经治疗的患者转变为不可逆转的残疾累积阶段，称为继发性MS。疾病修饰治疗(DMT)和这种转化之间的联系很少被研究，也从来没有使用过有效的定义。目的确定DMT的使用、类型和时机与转化为继发性进展性MS的风险之间的关联，这些风险被确诊为有效的定义。设计、设置和参与者使用来自21个国家的68个神经学中心的前瞻性数据进行队列研究，检查1988-2012年间开始进行DMT(或临床监测)的患者，并进行至少4年的随访。例如，以下DMT的使用、类型和时机：贝塔、格列吡喃、芬托利单抗、那塔利单抗或阿珠单抗。在倾向-评分匹配后，纳入1555名患者(最后一次随访，2017年2月14日)。主要结果和测量转换为客观定义的继发性进展MS。结果在1555名患者中，1123名为女性(平均基线年龄35岁[SD，10])。接受治疗的患者转化为继发性MS的风险比未接受治疗的患者低(HR，0.71；95%CI，0.61-0.81；P
IMPORTANCE Within 2 decades of onset, 80% of untreated patients with relapsing-remitting multiple sclerosis (MS) convert to a phase of irreversible disability accrual termed secondary progressiveMS. The association between disease-modifying treatments (DMTs), and this conversion has rarely been studied and never using a validated definition.OBJECTIVE To determine the association between the use, the type of, and the timing of DMTs with the risk of conversion to secondary progressive MS diagnosed with a validated definition.DESIGN, SETTING, AND PARTICIPANTS Cohort study with prospective data from 68 neurology centers in 21 countries examining patients with relapsing-remittingMS commencing DMTs (or clinical monitoring) between 1988-2012 with minimum 4 years' follow-up.EXPOSURES The use, type, and timing of the following DMTs: interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab. After propensity-score matching, 1555 patients were included (last follow-up, February 14, 2017).MAIN OUTCOME AND MEASURE Conversion to objectively defined secondary progressiveMS.RESULTS Of the 1555 patients, 1123 were female (mean baseline age, 35 years [SD, 10]). Patients initially treated with glatiramer acetate or interferon beta had a lower hazard of conversion to secondary progressiveMS than matched untreated patients (HR, 0.71; 95% CI, 0.61-0.81; P