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首页> 外文期刊>Journal of neurology >Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy
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Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy

机译：与切换到另一个中等有效的治疗相比，治疗升级导致复发较少

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BackgroundPatients with multiple sclerosis who experience disease breakthrough often switch disease-modifying therapy (DMT).ObjectiveTo compare treatment effectiveness of switch to highly effective DMT (heDMT) with switch to moderately effective DMT (meDMT) for patients who switch due to disease breakthrough defined as at least one relapse within 12months of their treatment switch.MethodsWe retrieved data from The Danish Multiple Sclerosis Registry on all relapsing-remitting MS patients with expanded disability status scale (EDSS) less than 6 who experienced disease breakthrough. We used propensity score matching to compare annualized relapse rates (ARRs), time to first confirmed relapse, time to first confirmedEDSS worsening and time to first confirmedEDSS improvement.ResultsEach matched group comprised 404 patients. Median follow-up time was 3.2years [interquartile range (IQR) 1.7-5.8]. ARRs were 0.22 (0.19-0.27) with heDMT and 0.32 (IQR 0.28-0.37) with meDMT; relapse rate ratio was 0.70 (95% CI0.56-0.86; p=0.001). Escalation to heDMT reduced the hazard of reaching a first relapse (HR 0.65; 95% CI 0.53-0.80; p0.001). We found no evidence of delayed disability worsening (HR 0.83; 95% CI 0.62-1.10; p=0.20) and weak evidence of disability improvement (HR 1.33; 95% CI 1.00-1.76; p=0.05) with heDMT.ConclusionSwitching to heDMT is associated with reduced ARR and delay of first relapse compared with switching to meDMT. Patients on DMT who experience relapses should escalate therapy to heDMT.
机译：背景包括多发性硬化的体验疾病突破通常切换疾病修饰治疗（DMT）.Bobjectiveto将切换到高效DMT（HEDMT）的处理效果与开关，为疾病突破导致的患者进行切换到适度有效的DMT（Medmt）。在其治疗开关中的12个月内至少一次复发。近似致丹麦多发性硬化登记处的数据检索在所有复发副硬化的MS患者中，延展的残疾状态规模（EDS）少于6岁的疾病突破。我们使用倾向得分匹配来比较年度复发率（ARRS），首次确认复发的时间，首先确认的时间恶化和第一次证实改善的时间。伴随着404名患者。中位后续时间为3.2年[四分位数范围（IQR）1.7-5.8]。 ARRS为0.22（0.19-0.27），HEDMT和0.32（IQR 0.28-0.37），Medmt;复发率比为0.70（95％CI0.56-0.86; P = 0.001）。对HEDMT的升级减少了达到第一次复发的危害（HR 0.65; 95％CI 0.53-0.80; P <0.001）。我们发现没有延迟残疾恶化的证据（HR 0.83; 95％CI 0.62-1.10; p = 0.20）和残疾改善的弱证据（hr 1.33; 95％ci 1.00-1.76; p = 0.05）与hedmt.conclusionswitching到hedmt与切换到Medmt相比，与第一次复发的延迟和延迟相关联。 DMT的患者经历复发的人应该将治疗升级到HEDMT。

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