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Clinical outcomes of escalation vs early intensive disease-modifying therapy in patients with multiple sclerosis

Harding, Katharine, Williams, Owain, Willis, Mark, Hrastelj, James, Rimmer, Anthony, Joseph, Fady, Tomassini, Valentina, Wardle, Mark, Pickersgill, Trevor, Robertson, Neil and Tallantyre, Emma 2019. Clinical outcomes of escalation vs early intensive disease-modifying therapy in patients with multiple sclerosis. JAMA Neurology , -. 10.1001/jamaneurol.2018.4905
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Abstract

Importance Uncertainty remains about how aggressively to treat early multiple sclerosis. High-efficacy disease-modifying therapies (DMTs) are often reserved for individuals expressing poor prognostic features at baseline. Objective To analyze long-term outcomes in a population-based cohort according to initial treatment strategy. Design, Setting and Participants In this cohort study, data were derived from January 1998 to December 2016, and analysis was performed in January 2017. From a total of 720 patients prescribed a DMT, 592 (82%) were included in analysis. Reasons for exclusion were first treated elsewhere or privately (n = 39), clinical trial participant (n = 25), and insufficient clinical data (n = 45). Exposures Patients were classified according to first-line treatment strategy: high-efficacy (early intensive treatment [EIT]) or moderate-efficacy DMT (escalation [ESC]). Main Outcomes and Measures Primary outcome was 5-year change in Expanded Disability Status Scale score. Secondary outcome was time to sustained accumulation of disability (SAD). Models were adjusted for sex, age at treatment, year of starting DMT, and escalation to high-efficacy treatment in the ESC group.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher: American Medical Association (AMA)
ISSN: 2168-6149
Date of First Compliant Deposit: 20 March 2019
Date of Acceptance: 13 December 2018
Last Modified: 30 Apr 2019 17:42
URI: http://orca.cf.ac.uk/id/eprint/120963

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