Benefits of early treatment with natalizumab : a real-world study
Copyright © 2022. Published by Elsevier B.V..
BACKGROUND: The impact of early versus later high-efficacy disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) is uncertain. This study reported the association of early versus later natalizumab treatment with real-world clinical outcomes in MS patients.
METHODS: The study included 661 participants diagnosed with MS in 1994 or later from 7 US centers participating in the MS Partners Advancing Technology for Health Solutions (MS PATHS) network. Time to natalizumab treatment between diagnosis and first infusion (TTNT) was determined from the Tysabri Outreach: Unified Commitment to Health (TOUCH) registry. Clinical outcomes were defined using neuroperformance tests included in the Multiple Sclerosis Performance Test. Associations were tested using TTNT as a categorical and continuous variable. Linear mixed models addressed within-subject and within-site clustering.
RESULTS: TTNT varied from 0.1 to 19.8 years (median [interquartile range] 4.2 [1.8, 9.0] years). A significant association between later natalizumab use and worse outcomes was demonstrated for walking speed (p < 0.001), processing speed (p < 0.001), manual dexterity (p < 0.001), brain atrophy (p = 0.001), and T2 lesion volume (p = 0.02). Covariate-adjusted modelling of a sensitivity population diagnosed with MS in 2006 or later (n = 424) demonstrated significant associations between longer TTNT and worse walking speed (p < 0.05), processing speed (p < 0.001), and manual dexterity (p < 0.001).
CONCLUSION: Later initiation of natalizumab was associated with worse clinical and radiologic imaging outcomes. Thus, high-efficacy DMT may have greater benefit when started earlier in MS patients. These results provide a rationale for randomized controlled trials to further assess the impact of early highly-effective DMT use versus later escalation of therapy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
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| Enthalten in: |
Multiple sclerosis and related disorders - 68(2022) vom: 15. Dez., Seite 104216 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ontaneda, Daniel [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical outcomes |
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| Anmerkungen: |
Date Completed 14.12.2022 Date Revised 21.12.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.msard.2022.104216 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM348030797 |
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| 520 | |a Copyright © 2022. Published by Elsevier B.V. | ||
| 520 | |a BACKGROUND: The impact of early versus later high-efficacy disease-modifying therapy (DMT) in patients with multiple sclerosis (MS) is uncertain. This study reported the association of early versus later natalizumab treatment with real-world clinical outcomes in MS patients | ||
| 520 | |a METHODS: The study included 661 participants diagnosed with MS in 1994 or later from 7 US centers participating in the MS Partners Advancing Technology for Health Solutions (MS PATHS) network. Time to natalizumab treatment between diagnosis and first infusion (TTNT) was determined from the Tysabri Outreach: Unified Commitment to Health (TOUCH) registry. Clinical outcomes were defined using neuroperformance tests included in the Multiple Sclerosis Performance Test. Associations were tested using TTNT as a categorical and continuous variable. Linear mixed models addressed within-subject and within-site clustering | ||
| 520 | |a RESULTS: TTNT varied from 0.1 to 19.8 years (median [interquartile range] 4.2 [1.8, 9.0] years). A significant association between later natalizumab use and worse outcomes was demonstrated for walking speed (p < 0.001), processing speed (p < 0.001), manual dexterity (p < 0.001), brain atrophy (p = 0.001), and T2 lesion volume (p = 0.02). Covariate-adjusted modelling of a sensitivity population diagnosed with MS in 2006 or later (n = 424) demonstrated significant associations between longer TTNT and worse walking speed (p < 0.05), processing speed (p < 0.001), and manual dexterity (p < 0.001) | ||
| 520 | |a CONCLUSION: Later initiation of natalizumab was associated with worse clinical and radiologic imaging outcomes. Thus, high-efficacy DMT may have greater benefit when started earlier in MS patients. These results provide a rationale for randomized controlled trials to further assess the impact of early highly-effective DMT use versus later escalation of therapy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Clinical outcomes | |
| 650 | 4 | |a Multiple sclerosis | |
| 650 | 4 | |a Natalizumab | |
| 650 | 4 | |a Radiological outcomes | |
| 650 | 7 | |a Natalizumab |2 NLM | |
| 700 | 1 | |a Mowry, Ellen M |e verfasserin |4 aut | |
| 700 | 1 | |a Newsome, Scott D |e verfasserin |4 aut | |
| 700 | 1 | |a Naismith, Robert T |e verfasserin |4 aut | |
| 700 | 1 | |a Nicholas, Jacqueline |e verfasserin |4 aut | |
| 700 | 1 | |a Fisher, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a de Moor, Carl |e verfasserin |4 aut | |
| 700 | 1 | |a Bohn, Justin |e verfasserin |4 aut | |
| 700 | 1 | |a Ho, Pei-Ran |e verfasserin |4 aut | |
| 700 | 1 | |a Sandrock, Al |e verfasserin |4 aut | |
| 700 | 1 | |a Rudick, Richard |e verfasserin |4 aut | |
| 700 | 1 | |a Williams, James R |e verfasserin |4 aut | |
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