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Riley N, Drudge C, Nelson M, Haltner A, Barnett M, Broadley S, Butzkueven H, McCombe P, Van der Walt A, Wong EOY, Merschhemke M, Adlard N, Walker R, Samjoo IA. Comparative efficacy of ofatumumab versus oral therapies for relapsing multiple sclerosis patients using propensity score analyses and simulated treatment comparisons. Ther Adv Neurol Disord 2024; 17:17562864241239453. [PMID: 38525490 PMCID: PMC10960976 DOI: 10.1177/17562864241239453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Background Evidence from network meta-analyses (NMAs) and real-world propensity score (PS) analyses suggest monoclonal antibodies (mAbs) offer a therapeutic advantage over currently available oral therapies and, therefore, warrant consideration as a distinct group of high-efficacy disease-modifying therapies (DMTs) for patients with relapsing multiple sclerosis (RMS). This is counter to the current perception of these therapies by some stakeholders, including payers. Objectives A multifaceted indirect treatment comparison (ITC) approach was undertaken to clarify the relative efficacy of mAbs and oral therapies. Design Two ITC methods that use individual patient data (IPD) to adjust for between-trial differences, PS analyses and simulated treatment comparisons (STCs), were used to compare the mAb ofatumumab versus the oral therapies cladribine, fingolimod, and ozanimod. Data sources and methods As IPD were available for trials of ofatumumab and fingolimod, PS analyses were conducted. Given summary-level data were available for cladribine, fingolimod, and ozanimod trials, STCs were conducted between ofatumumab and each of these oral therapies. Three efficacy outcomes were compared: annualized relapse rate (ARR), 3-month confirmed disability progression (3mCDP), and 6-month CDP (6mCDP). Results The PS analyses demonstrated ofatumumab was statistically superior to fingolimod for ARR and time to 3mCDP but not time to 6mCDP. In STCs, ofatumumab was statistically superior in reducing ARR and decreasing the proportion of patients with 3mCDP compared with cladribine, fingolimod, and ozanimod and in decreasing the proportion with 6mCP compared with fingolimod and ozanimod. These findings were largely consistent with recently published NMAs that identified mAb therapies as the most efficacious DMTs for RMS. Conclusion Complementary ITC methods showed ofatumumab was superior to cladribine, fingolimod, and ozanimod in lowering relapse rates and delaying disability progression among patients with RMS. Our study supports the therapeutic superiority of mAbs over currently available oral DMTs for RMS and the delineation of mAbs as high-efficacy therapies.
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Affiliation(s)
- Nicholas Riley
- Novartis Pharmaceuticals Australia, Sydney, NSW, Australia
| | | | - Morag Nelson
- Novartis Pharmaceuticals Australia, Sydney, NSW, Australia
| | | | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Simon Broadley
- School of Medicine, Griffith University, Southport, QLD, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Pamela McCombe
- UQ Centre for Clinical Research Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Anneke Van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | | | | | - Rob Walker
- Novartis Pharmaceuticals Australia, Sydney, NSW, Australia
| | - Imtiaz A. Samjoo
- EVERSANA, Value and Evidence, 113-3228 South Service Road, Burlington, ON, Canada, L7N 3H8
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Roos I, Kalincik T. Comparative Efficacy of Disease-Modifying Treatments for Relapsing Multiple Sclerosis-Variations in Real-World Experience-Reply. JAMA Neurol 2024; 81:87-88. [PMID: 37983053 DOI: 10.1001/jamaneurol.2023.4392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Izanne Roos
- Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Tomas Kalincik
- Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Diouf I, Malpas CB, Sharmin S, Roos I, Horakova D, Kubala Havrdova E, Patti F, Shaygannejad V, Ozakbas S, Eichau S, Onofrj M, Lugaresi A, Alroughani R, Prat A, Duquette P, Terzi M, Boz C, Grand'Maison F, Sola P, Ferraro D, Grammond P, Yamout B, Altintas A, Gerlach O, Lechner-Scott J, Bergamaschi R, Karabudak R, Iuliano G, McGuigan C, Cartechini E, Hughes S, Sa MJ, Solaro C, Kappos L, Hodgkinson S, Slee M, Granella F, de Gans K, McCombe PA, Ampapa R, van der Walt A, Butzkueven H, Sánchez-Menoyo JL, Vucic S, Laureys G, Sidhom Y, Gouider R, Castillo-Trivino T, Gray O, Aguera-Morales E, Al-Asmi A, Shaw C, Al-Harbi TM, Csepany T, Sempere AP, Treviño Frenk I, Stuart EA, Kalincik T. Effectiveness of multiple disease-modifying therapies in relapsing-remitting multiple sclerosis: causal inference to emulate a multiarm randomised trial. J Neurol Neurosurg Psychiatry 2023; 94:1004-1011. [PMID: 37414534 DOI: 10.1136/jnnp-2023-331499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Simultaneous comparisons of multiple disease-modifying therapies for relapsing-remitting multiple sclerosis (RRMS) over an extended follow-up are lacking. Here we emulate a randomised trial simultaneously comparing the effectiveness of six commonly used therapies over 5 years. METHODS Data from 74 centres in 35 countries were sourced from MSBase. For each patient, the first eligible intervention was analysed, censoring at change/discontinuation of treatment. The compared interventions included natalizumab, fingolimod, dimethyl fumarate, teriflunomide, interferon beta, glatiramer acetate and no treatment. Marginal structural Cox models (MSMs) were used to estimate the average treatment effects (ATEs) and the average treatment effects among the treated (ATT), rebalancing the compared groups at 6-monthly intervals on age, sex, birth-year, pregnancy status, treatment, relapses, disease duration, disability and disease course. The outcomes analysed were incidence of relapses, 12-month confirmed disability worsening and improvement. RESULTS 23 236 eligible patients were diagnosed with RRMS or clinically isolated syndrome. Compared with glatiramer acetate (reference), several therapies showed a superior ATE in reducing relapses: natalizumab (HR=0.44, 95% CI=0.40 to 0.50), fingolimod (HR=0.60, 95% CI=0.54 to 0.66) and dimethyl fumarate (HR=0.78, 95% CI=0.66 to 0.92). Further, natalizumab (HR=0.43, 95% CI=0.32 to 0.56) showed a superior ATE in reducing disability worsening and in disability improvement (HR=1.32, 95% CI=1.08 to 1.60). The pairwise ATT comparisons also showed superior effects of natalizumab followed by fingolimod on relapses and disability. CONCLUSIONS The effectiveness of natalizumab and fingolimod in active RRMS is superior to dimethyl fumarate, teriflunomide, glatiramer acetate and interferon beta. This study demonstrates the utility of MSM in emulating trials to compare clinical effectiveness among multiple interventions simultaneously.
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Affiliation(s)
- Ibrahima Diouf
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Health and Biosecurity Unit, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Izanne Roos
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dana Horakova
- Department of Neurology, Center of Clinical Neuroscience, Charles University, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology, Center of Clinical Neuroscience, Charles University, Praha, Czech Republic
- General University Hospital in Prague, Praha, Czech Republic
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania 'G.F. Ingrassia', Catania, Italy
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | | | - Sara Eichau
- Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marco Onofrj
- Deptartment of Neuroscience, Imaging, and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait
| | - Alexandre Prat
- CHUM MS Center, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Pierre Duquette
- CHUM MS Center, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Murat Terzi
- CHUM MS Center, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Cavit Boz
- School of Medicine, Ondokuz Mayis Universitesi, Samsun, Turkey
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Neurology, American University of Beirut, Beirut, Lebanon
| | - Ayse Altintas
- Department of Neurology, Koc Universitesi, Istanbul, Turkey
- Koc University Research Center for Translational Medicine, Istanbul, Turkey
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jeannette Lechner-Scott
- University of Newcastle Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Roberto Bergamaschi
- Foundation National Neurological Institute C Mondino Institute for Hospitalization and Care Scientific, Pavia, Italy
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | | | | | - Maria Jose Sa
- Department of Neurology, Centro Hospitalar de São João, Porto, Portugal
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitaiton, Casa di Cura Centro di Recupero e Rieducazione Funzionale Mons Luigi Novarese, Moncrivello, Italy
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Neurologic Clinic and Policlinic, Departments of Head, Spine and Neuromedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Pamela A McCombe
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Anneke van der Walt
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Steve Vucic
- Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Youssef Sidhom
- Department of Neurology, Razi University Hospital, Tunis, Tunisia
- Department of Neurology, University of Tunis El Manar, Tunis, Tunisia
| | - Riadh Gouider
- Department of Neurology, University of Tunis El Manar, Tunis, Tunisia
| | - Tamara Castillo-Trivino
- Instituto de Investigacion Sanitaria Biodonostia, Hospital Universitario de Donostia, San Sebastian, Spain
| | - Orla Gray
- South and East Belfast Health and Social Services Trust, Belfast, UK
| | | | - Abdullah Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Seeb, Oman
- Sultan Qaboos University, Muscat, Oman
| | - Cameron Shaw
- University Hospital Geelong, Geelong, Victoria, Australia
| | - Talal M Al-Harbi
- Department of Neurology, King Fahad Specialist Hospital-Dammam, Khobar, Saudi Arabia
| | - Tunde Csepany
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Angel P Sempere
- Department of Neurology, Hospital General de Alicante, Alicante, Spain
| | - Irene Treviño Frenk
- Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Elizabeth A Stuart
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
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4
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Roos I, Diouf I, Sharmin S, Horakova D, Havrdova EK, Patti F, Shaygannejad V, Ozakbas S, Izquierdo G, Eichau S, Onofrj M, Lugaresi A, Alroughani R, Prat A, Girard M, Duquette P, Terzi M, Boz C, Grand'Maison F, Sola P, Ferraro D, Grammond P, Turkoglu R, Buzzard K, Skibina O, Yamou B, Altintas A, Gerlach O, van Pesch V, Blanco Y, Maimone D, Lechner-Scott J, Bergamaschi R, Karabudak R, McGuigan C, Cartechini E, Barnett M, Hughes S, Sa MJ, Solaro C, Ramo-Tello C, Hodgkinson S, Spitaleri D, Soysal A, Petersen T, Granella F, de Gans K, McCombe P, Ampapa R, Van Wijmeersch B, van der Walt A, Butzkueven H, Prevost J, Sanchez-Menoyo JL, Laureys G, Gouider R, Castillo-Triviño T, Gray O, Aguera-Morales E, Al-Asmi A, Shaw C, Deri N, Al-Harbi T, Fragoso Y, Csepany T, Sempere AP, Trevino-Frenk I, Schepel J, Moore F, Malpas C, Kalincik T. Comparative effectiveness in multiple sclerosis: A methodological comparison. Mult Scler 2023; 29:326-332. [PMID: 36800908 DOI: 10.1177/13524585231151394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND In the absence of evidence from randomised controlled trials, observational data can be used to emulate clinical trials and guide clinical decisions. Observational studies are, however, susceptible to confounding and bias. Among the used techniques to reduce indication bias are propensity score matching and marginal structural models. OBJECTIVE To use the comparative effectiveness of fingolimod vs natalizumab to compare the results obtained with propensity score matching and marginal structural models. METHODS Patients with clinically isolated syndrome or relapsing remitting MS who were treated with either fingolimod or natalizumab were identified in the MSBase registry. Patients were propensity score matched, and inverse probability of treatment weighted at six monthly intervals, using the following variables: age, sex, disability, MS duration, MS course, prior relapses, and prior therapies. Studied outcomes were cumulative hazard of relapse, disability accumulation, and disability improvement. RESULTS 4608 patients (1659 natalizumab, 2949 fingolimod) fulfilled inclusion criteria, and were propensity score matched or repeatedly reweighed with marginal structural models. Natalizumab treatment was associated with a lower probability of relapse (PS matching: HR 0.67 [95% CI 0.62-0.80]; marginal structural model: 0.71 [0.62-0.80]), and higher probability of disability improvement (PS matching: 1.21 [1.02 -1.43]; marginal structural model 1.43 1.19 -1.72]). There was no evidence of a difference in the magnitude of effect between the two methods. CONCLUSIONS The relative effectiveness of two therapies can be efficiently compared by either marginal structural models or propensity score matching when applied in clearly defined clinical contexts and in sufficiently powered cohorts.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Ibrahima Diouf
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Catania, Italy/Multiple Sclerosis Center, University of Catania, Catania, Italy
| | | | | | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy/IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | - Marc Girard
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | - Pierre Duquette
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Katherine Buzzard
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia/Monash University, Melbourne, VIC, Australia/Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia/The Alfred Hospital, Melbourne, VIC, Australia
| | - Bassem Yamou
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayse Altintas
- Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul, Turkey
| | - Oliver Gerlach
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands/School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium/Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi, Catania, Italy
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, NSW, Australia/Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | | | | | | | | | | | | | - Maria José Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy/Department of Rehabilitation, M.L. Novarese Hospital Moncrivello, Moncrivello, Italy
| | | | - Suzanne Hodgkinson
- Immune Tolerance Laboratory, Ingham Institute and Department of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy/Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | | | - Pamela McCombe
- The University of Queensland, Brisbane, QLD, Australia/Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | - Bart Van Wijmeersch
- Rehabilitation & MS Centre, University MS Centre, Noorderhart Hospital, Pelt, Belgium/Pelt and Hasselt University, Hasselt, Belgium
| | - Anneke van der Walt
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia/Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia/Central Clinical School, Monash University, Clayton, VIC, Australia
| | | | | | - Guy Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Manouba, Tunisia
| | | | - Orla Gray
- South Eastern HSC Trust, Belfast, UK
| | | | - Abdullah Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Al-Khodh, Oman
| | | | - Norma Deri
- Hospital Fernandez, Capital Federal, Buenos Aires, Argentina
| | - Talal Al-Harbi
- Neurology Department, King Fahad Specialist Hospital-Dammam, Khobar, Saudi Arabia
| | - Yara Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Irene Trevino-Frenk
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Charles Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Spelman T, Horakova D, Ozakbas S, Alroughani R, Onofrj M, Kalincik T, Prat A, Terzi M, Grammond P, Patti F, Csepany T, Boz C, Lechner-Scott J, Granella F, Grand'Maison F, van der Walt A, Zhu C, Butzkueven H. Switching to natalizumab or fingolimod in multiple sclerosis: Comparative effectiveness and effect of pre-switch disease activity. Mult Scler Relat Disord 2023; 70:104477. [PMID: 36746088 DOI: 10.1016/j.msard.2022.104477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide; collectively, "BRACETD") often switch to another therapy, including natalizumab or fingolimod. Here we compare the effectiveness of switching from a first-line therapy to natalizumab or fingolimod after ≥1 relapse. METHODS Data collected prospectively in the MSBase Registry, a global, longitudinal, observational registry, were extracted on February 6, 2018. Included patients were adults with RRMS with ≥1 relapse on BRACETD therapy in the year before switching to natalizumab or fingolimod. Included patients received natalizumab or fingolimod for ≥3 months after the switch. RESULTS Following 1:1 propensity score matching, 1000 natalizumab patients were matched to 1000 fingolimod patients. Mean (standard deviation) follow-up time was 3.02 (2.06) years after switching to natalizumab and 2.58 (1.64) years after switching to fingolimod. Natalizumab recipients had significantly lower annualized relapse rate (relative risk=0.66; 95% confidence interval [CI], 0.59-0.74), lower risk of first relapse (hazard ratio [HR]=0.69; 95% CI, 0.60-0.80), and higher confirmed disability improvement (HR=1.27; 95% CI, 1.03-1.57) than fingolimod recipients. No difference in confirmed disability worsening was observed. CONCLUSIONS Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab than with fingolimod.
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Affiliation(s)
- Tim Spelman
- Central Clinical School, Monash University, Melbourne, VIC, Australia, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, and Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alexandre Prat
- Hôpital Notre Dame, Montreal, QC, Canada, and CHUM and Université de Montréal, Montreal, QC, Canada
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, AOU Policlinico Vittorio Emanuele, and Policlinico G. Rodolico, Catania, Italy
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, and Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Chao Zhu
- Department of Neurology, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Central Clinical School and Department of Neurology, Monash University, and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
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Rollot F, Couturier J, Casey R, Wiertlewski S, Debouverie M, Pelletier J, De Sèze J, Labauge P, Ruet A, Thouvenot E, Ciron J, Berger E, Gout O, Clavelou P, Stankoff B, Casez O, Bourre B, Zephir H, Moreau T, Lebrun-Frenay C, Maillart E, Edan G, Neau JP, Montcuquet A, Cabre P, Camdessanché JP, Defer G, Nasr HB, Maurousset A, Hankiewicz K, Pottier C, Leray E, Vukusic S, Laplaud DA. Comparative Effectiveness of Natalizumab Versus Anti-CD20 in Highly Active Relapsing-Remitting Multiple Sclerosis After Fingolimod Withdrawal. Neurotherapeutics 2022; 19:476-490. [PMID: 35217934 PMCID: PMC9226262 DOI: 10.1007/s13311-022-01202-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 10/19/2022] Open
Abstract
In France, two therapeutic strategies can be offered after fingolimod (FNG) withdrawal to highly active relapsing-remitting multiple sclerosis (RRMS) patients: natalizumab (NTZ) or anti-CD20. We compared the effectiveness of these two strategies as a switch for FNG within the OFSEP database. The primary endpoint was the time to first relapse. Other outcomes were the relapse rates over 3-month periods, time to worsening the EDSS score, proportion of patients with worsened 24-month MRI, time to treatment discontinuation, and incidence rates of serious adverse events. The dynamics of event rates over time were modeled using multidimensional penalized splines, allowing the possibility to model the effects of covariates in a flexible way, considering non-linearity and interactions. A total of 740 patients were included (337 under anti-CD20 and 403 under NTZ). There was no difference between the two treatments regarding the dynamic of the first occurrence of relapse, with a monthly probability of 5.0% at initiation and 1.0% after 6 months. The rate of EDSS worsening increased in both groups until 6 months and then decreased. No difference in the proportion of patients with new T2 lesions at 24 months was observed. After 18 months of follow-up, a greater risk of NTZ discontinuation was found compared to anti-CD20. This study showed no difference between NTZ and anti-CD20 after the FNG switch regarding the clinical and radiological activity. The effect of these treatments was optimal after 6 months and there was more frequent discontinuation of NTZ after 18 months, probably mainly related to JC virus seroconversions.
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Affiliation(s)
- Fabien Rollot
- Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France.
- Service de Neurologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Bron, France.
- Centre de Recherche en Neurosciences de Lyon, Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR 5292, Lyon, France.
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France.
| | | | - Romain Casey
- Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
- Service de Neurologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR 5292, Lyon, France
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Sandrine Wiertlewski
- Service de Neurologie, CHU Nantes, Nantes, France
- INSERM, CIC 0004, CRTI-INSERM UMR U1064, Nantes, France
| | - Marc Debouverie
- Service de Neurologie, Centre Hospitalier Régional Et Universitaire de Nancy, Université de Lorraine, 4360 APEMAC, Vandoeuvre-Lès-Nancy, EA, France
| | - Jean Pelletier
- Aix Marseille University, APHM, Hôpital de La Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, CEMEREM, 13005, Marseille, France
| | - Jérôme De Sèze
- Service de Neurologie Et Centre d'Investigation Clinique, CHU de Strasbourg, INSERM 1434, Strasbourg, France
| | - Pierre Labauge
- Service de Neurologie, CHU de Montpellier, Montpellier, France
| | - Aurélie Ruet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France
- Université de Bordeaux, INSERM, Neurocentre Magendie, U1215, Bordeaux, France
| | - Eric Thouvenot
- Service de Neurologie, CHU de Nîmes, Nîmes, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Jonathan Ciron
- Service de Neurologie, CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP, Toulouse, France
- Institut Toulousain Des Maladies Infectieuses Et Inflammatoires (Infinity), INSERM UMR 1291, CNRS UMR 5051, Université Toulouse III, Toulouse, France
| | - Eric Berger
- Service de Neurologie, CHU de Besançon, Besançon, France
| | - Olivier Gout
- Service de Neurologie, Hôpital Fondation A de Rothschild, Paris, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Olivier Casez
- Service de Neurologie, CHU de Grenoble, Grenoble, France
| | | | - Hélène Zephir
- Pôle Des Neurosciences Et de L'appareil Locomoteur, CRC-SEP, Hôpital Roger Salengro, Université de Lille, Inserm U1172, Lille, France
| | | | - Christine Lebrun-Frenay
- Service de Neurologie, Neurologie Pasteur 2, CHU de Nice, Université Nice Cote d'Azur UR2CA-URRIS, Nice, France
| | - Elisabeth Maillart
- Département de Neurologie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Gilles Edan
- Service de Neurologie, CHU Pontchaillou, Rennes, France
| | | | | | - Philippe Cabre
- Service de Neurologie, CHU de Fort de France, Fort de France, France
| | | | - Gilles Defer
- Service de Neurologie, Centre Expert SEP, CHU de Caen, Université Normandie, Caen, France
| | - Haifa Ben Nasr
- Service de Neurologie, Hôpital Sud Francilien, Corbeil Essonnes, France
| | | | | | | | - Emmanuelle Leray
- Université de Rennes/EHESP, REPERES - EA, 7449, Rennes, France
- CHU Rennes, CIC-P 1414, Rennes, France
| | - Sandra Vukusic
- Université de Lyon, Université Claude Bernard, Lyon 1, Lyon, France
- Service de Neurologie, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR 5292, Lyon, France
- EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - David-Axel Laplaud
- Service de Neurologie, CHU Nantes, Nantes, France.
- INSERM, CIC 0004, CRTI-INSERM UMR U1064, Nantes, France.
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Sharmin S, Lefort M, Andersen JB, Leray E, Horakova D, Havrdova EK, Alroughani R, Izquierdo G, Ozakbas S, Patti F, Onofrj M, Lugaresi A, Terzi M, Grammond P, Grand'Maison F, Yamout B, Prat A, Girard M, Duquette P, Boz C, Trojano M, McCombe P, Slee M, Lechner-Scott J, Turkoglu R, Sola P, Ferraro D, Granella F, Prevost J, Maimone D, Skibina O, Buzzard K, Van der Walt A, Van Wijmeersch B, Csepany T, Spitaleri D, Vucic S, Casey R, Debouverie M, Edan G, Ciron J, Ruet A, De Sèze J, Maillart E, Zephir H, Labauge P, Defer G, Lebrun-Frénay C, Moreau T, Berger E, Clavelou P, Pelletier J, Stankoff B, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Wahab A, Camdessanché JP, Maurousset A, Patry I, Hankiewicz K, Pottier C, Maubeuge N, Labeyrie C, Nifle C, Laplaud D, Koch-Henriksen N, Sellebjerg FT, Soerensen PS, Pfleger CC, Rasmussen PV, Jensen MB, Frederiksen JL, Bramow S, Mathiesen HK, Schreiber KI, Magyari M, Vukusic S, Butzkueven H, Kalincik T. Natalizumab Versus Fingolimod in Patients with Relapsing-Remitting Multiple Sclerosis: A Subgroup Analysis From Three International Cohorts. CNS Drugs 2021; 35:1217-1232. [PMID: 34536228 DOI: 10.1007/s40263-021-00860-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Natalizumab has proved to be more effective than fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RRMS). Whether this association is universal for all patient groups remains to be determined. OBJECTIVE The aim of this study was to compare the relative effectiveness of natalizumab and fingolimod in RRMS subgroups defined by the baseline demographic and clinical characteristics of interest. METHODS Patients with RRMS who were given natalizumab or fingolimod were identified in a merged cohort from three international registries. Efficacy outcomes were compared across subgroups based on patients' sex, age, disease duration, Expanded Disability Status Scale (EDSS) score, and disease and magnetic resonance imaging (MRI) activity 12 months prior to treatment initiation. Study endpoints were number of relapses (analyzed with weighted negative binomial generalized linear model) and 6-month confirmed disability worsening and improvement events (weighted Cox proportional hazards model), recorded during study therapy. Each patient was weighted using inverse probability of treatment weighting based on propensity score. RESULTS A total of 5148 patients (natalizumab 1989; fingolimod 3159) were included, with a mean ± standard deviation age at baseline of 38 ± 10 years, and the majority (72%) were women. The median on-treatment follow-up was 25 (quartiles 15-41) months. Natalizumab was associated with fewer relapses than fingolimod (incidence rate ratio [IRR]; 95% confidence interval [CI]) in women (0.76; 0.65-0.88); in those aged ≤ 38 years (0.64; 0.54-0.76); in those with disease duration ≤ 7 years (0.63; 0.53-0.76); in those with EDSS score < 4 (0.75; 0.64-0.88), < 6 (0.80; 0.70-0.91), and ≥ 6 (0.52; 0.31-0.86); and in patients with pre-baseline relapses (0.74; 0.64-0.86). A higher probability of confirmed disability improvement on natalizumab versus fingolimod (hazard ratio [HR]; 95% CI) was observed among women (1.36; 1.10-1.66); those aged > 38 years (1.34; 1.04-1.73); those with disease duration > 7 years (1.33; 1.01-1.74); those with EDSS score < 6 (1.21; 1.01-1.46) and ≥ 6 (1.93; 1.11-3.34); and patients with no new MRI lesion (1.73; 1.19-2.51). CONCLUSIONS Overall, in women, younger patients, those with shorter disease durations, and patients with pre-treatment relapses, natalizumab was associated with a lower frequency of multiple sclerosis relapses than fingolimod. It was also associated with an increased chance of recovery from disability among most patients, particularly women and those with no recent MRI activity.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, L4 East, Grattan St, Melbourne, VIC, 3050, Australia
| | - Mathilde Lefort
- Rennes University, EHESP, REPERES, EA, 7449, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Johanna Balslev Andersen
- The Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES, EA, 7449, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.,Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | | | | | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, Canada
| | - Marc Girard
- CHUM MS Center and Universite de Montreal, Montreal, Canada
| | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | | | | | - Olga Skibina
- Department of Neuroscience, Monash University, Melbourne, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Katherine Buzzard
- Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Anneke Van der Walt
- Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Steve Vucic
- Neurophysiology Department, Westmead Hospital, Sydney, Australia
| | - Romain Casey
- Université de Lyon, Université, Claude Bernard Lyon 1, F-69000, Lyon, France.,Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, Lyon, France.,Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, 69003, Lyon, France.,EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Nancy, France.,Université de Lorraine, APEMAC, 54000, Nancy, France
| | - Gilles Edan
- CHU Pontchaillou, CIC1414 INSERM, 35000, Rennes, France
| | - Jonathan Ciron
- Department of Neurology, CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP, 31059, Toulouse Cedex 9, France
| | - Aurélie Ruet
- Neurocentre Magendie, Université de Bordeaux, 33000, Bordeaux, France.,INSERM U1215, Neurocentre Magendie, 33000, Bordeaux, France.,Department of Neurology, CHU de Bordeaux, CIC Bordeaux CIC1401, 33000, Bordeaux, France
| | - Jérôme De Sèze
- Department of Neurology and Clinical Investigation Center, CHU de Strasbourg, CIC 1434, INSERM 1434, 67000, Strasbourg, France
| | - Elisabeth Maillart
- Département de neurologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France.,Centre de Ressources et de Compétences SEP, Paris, France
| | - Hélène Zephir
- CHU Lille, CRCSEP Lille, Univ Lille, U1172, 59000, Lille, France
| | - Pierre Labauge
- MS Unit, CHU de Montpellier, 34295, Montpellier Cedex 5, France.,University of Montpellier (MUSE), 34000, Montpellier, France
| | - Gilles Defer
- Department of Neurology, CHU de Caen, MS Expert Centre, Normandy University, avenue de la Côte-de-Nacre, 14033, Caen, France
| | | | - Thibault Moreau
- Department of Neurology, CHU de Dijon, EA4184, 21000, Dijon, France
| | - Eric Berger
- CHU de Besançon, Service de Neurologie 25 030, Besançon, France
| | - Pierre Clavelou
- Department of Neurology, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, Inserm, Neuro-Dol, 63000, Clermont-Ferrand, France
| | - Jean Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005, Marseille, France
| | - Bruno Stankoff
- Sorbonne Universités, UPMC Paris 06, Brain and Spine Institute, ICM, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France.,Department of Neurology, AP-HP, Saint-Antoine Hospital, 75000, Paris, France
| | - Olivier Gout
- Department of Neurology, Fondation Rotschild, 75000, Paris, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, 30029, Nimes Cedex 9, France.,Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Univ. Montpellier, 34094, Montpellier Cedex 5, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital de Poissy, 78300, Poissy, France
| | | | | | - Olivier Casez
- Department of Neurology, CHU Grenoble Alpes, La Tronche, 38700, Grenoble, France
| | - Philippe Cabre
- Department of Neurology, CHU de la Martinique, 97200, Fort-de-France, France
| | - Alexis Montcuquet
- Department of Neurology, CHU de Limoges, Hôpital Dupuytren, 87000, Limoges, France
| | - Abir Wahab
- Department of Neurology, APHP, Hôpital Henri Mondor, 94000, Créteil, France
| | | | - Aude Maurousset
- CRC SEP and Department of Neurology, CHU de Tours, Hôpital Bretonneau, 37000, Tours, France
| | - Ivania Patry
- Department of Neurology, Hôpital Sud Francilien, 91160, Corbeil Essonnes, France
| | - Karolina Hankiewicz
- Department of Neurology, Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, 93200, Saint-Denis, France
| | - Corinne Pottier
- Department of Neurology, CH de Pontoise, Hôpital René Dubos, 95300, Pontoise, France
| | - Nicolas Maubeuge
- Department of Neurology, CHU La Milétrie, Hôpital Jean Bernard, 86000, Poitiers, France
| | - Céline Labeyrie
- Department of Neurology, CHU Bicêtre, 94275, Le Kremlin Bicêtre, France
| | - Chantal Nifle
- Department of Neurology, Centre Hospitalier de Versailles, 78150, Le Chesnay, France
| | - David Laplaud
- CHU de Nantes, Service de Neurologie & CIC015 INSERM, 44093, Nantes, France.,CRTI-Inserm U1064, 44000, Nantes, France
| | - Niels Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Thorup Sellebjerg
- Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Per Soelberg Soerensen
- Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Jette Lautrup Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Bramow
- Department of Neurology, Danish Multiple Sclerosis Centre, Copenhagen University Hospital, Rigshospitalet in Glostrup, 2600, Glostrup, Denmark
| | | | - Karen Ingrid Schreiber
- Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, Lyon, France.,Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, 69003, Lyon, France.,Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, F-69000, Lyon, France
| | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, L4 East, Grattan St, Melbourne, VIC, 3050, Australia. .,MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
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