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Induction Versus Escalation in Multiple Sclerosis: A 10-Year Real World Study.

Luca Prosperini1, Chiara Rosa Mancinelli2, Claudio Marcello Solaro3

  • 1Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy. luca.prosperini@gmail.com.

Neurotherapeutics : the Journal of the American Society for Experimental Neurotherapeutics
|April 3, 2020
PubMed
Summary

Induction immunosuppression was more effective than escalation strategies in reducing disability progression in multiple sclerosis patients with poor prognostic factors over 10 years. However, induction was associated with a higher rate of serious adverse events.

Keywords:
Multiple sclerosisescalationinductiontherapeutic algorithm

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Area of Science:

  • Neuroimmunology
  • Clinical Neurology
  • Pharmacology

Background:

  • Relapsing-remitting multiple sclerosis (RRMS) requires effective initial treatment strategies to prevent long-term disability.
  • Comparing induction immunosuppression with escalation therapy is crucial for optimizing patient outcomes in early-stage RRMS.
  • Understanding the long-term risk-benefit profile of different treatment strategies is essential for managing multiple sclerosis.

Purpose of the Study:

  • To directly compare the efficacy of induction immunosuppression versus escalation strategies on the risk of reaching a significant disability milestone (Expanded Disability Status Scale [EDSS] ≥ 6.0) over 10 years.
  • To evaluate the safety profiles of induction and escalation treatments in previously untreated RRMS patients.
  • To assess treatment effectiveness in patients with poor prognostic factors.

Main Methods:

  • Independent, multicenter, post-marketing study comparing initial treatment with interferon beta (escalation) versus mitoxantrone or cyclophosphamide (induction).
  • Propensity score matching was used to control for baseline differences between treatment groups in a cohort of 75 patients per group.
  • Cox models stratified by matched pairs were employed to analyze the time to reaching the EDSS ≥ 6.0 milestone over 10 years.

Main Results:

  • After propensity score matching, induction therapy was associated with a significantly lower proportion of patients reaching the disability milestone (28.0%) compared to escalation therapy (38.7%) (Hazard Ratio = 0.48, p=0.024).
  • Serious adverse events occurred more frequently in the induction group (10.7%) than in the escalation group (2.4%) (Odds Ratio = 3.36, p=0.015).
  • Patients receiving induction therapy were older and more disabled at baseline.

Conclusions:

  • Induction immunosuppression demonstrated greater effectiveness than escalation in reducing disability progression in RRMS patients with poor prognostic factors over a 10-year period.
  • The improved efficacy of induction therapy was accompanied by a worse safety profile, indicated by a higher incidence of serious adverse events.
  • Further research is needed to explore newer induction agents that may offer a more favorable long-term risk-benefit balance.