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Iaffaldano P, Lucisano G, Guerra T, Patti F, Cocco E, De Luca G, Brescia Morra V, Pozzilli C, Zaffaroni M, Ferraro D, Gasperini C, Salemi G, Bergamaschi R, Lus G, Inglese M, Romano S, Bellantonio P, Di Monte E, Maniscalco GT, Conte A, Lugaresi A, Vianello M, Torri Clerici VLA, Di Sapio A, Pesci I, Granella F, Totaro R, Marfia GA, Danni MC, Cavalla P, Valentino P, Aguglia U, Montepietra S, Ferraro E, Protti A, Spitaleri D, Avolio C, De Riz M, Maimone D, Cavaletti G, Gazzola P, Tedeschi G, Sessa M, Rovaris M, Di Palma F, Gatto M, Cargnelutti D, De Robertis F, Logullo FO, Rini A, Meucci G, Ardito B, Banfi P, Nasuelli D, Paolicelli D, Rocca MA, Portaccio E, Chisari CG, Fenu G, Onofrj M, Carotenuto A, Ruggieri S, Tortorella C, Ragonese P, Nica M, Amato MP, Filippi M, Trojano M. Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry. J Neurol 2024; 271:1150-1159. [PMID: 38135850 DOI: 10.1007/s00415-023-12137-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD). METHODS RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs]. RESULTS A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs. CONCLUSIONS More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Giovanna De Luca
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit and Multiple Sclerosis Center, ASST Della Valle Olona, Hospital of Gallarate, Via Pastori 4, 21013, Gallarate, VA, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di BaggiovaraAzienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matilde Inglese
- Dipartimento di NeuroscienzeRiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), Universita' di Genova, Genova, Italy
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Italy
| | | | - Elisabetta Di Monte
- Center for Multiple Sclerosis, Hospital ASL 4 "Madonna delle Grazie", 75100, Matera, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- Neurophysiopatology Unit, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marika Vianello
- MS Unit, OU Neurology "Ca' Foncello" Hospital, Treviso, Italy
| | | | - Alessia Di Sapio
- Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ilaria Pesci
- Neurology Unit, Ospedale Vaio-Fidenza, Parma, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rocco Totaro
- Centro Malattie Demielinizzanti-Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Coppito, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Maura Chiara Danni
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Valentino
- Istituto di neurologia, Università Magna Graecia Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sara Montepietra
- MS Centre, SMN Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Carlo Avolio
- MS Center, University of Neurology, Foggia, Italy
| | - Milena De Riz
- Centro Sclerosi Multipla-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, ARNAS Garibaldi, Catania, Italy
| | | | - Paola Gazzola
- SC Neurologia, Ospedale P. Antero Micone-ASL 3 Genovese, Genoa, Italy
| | - Gioacchino Tedeschi
- I Division of Neurology, Universita della Campania "L. Vanvitelli", Naples, Italy
| | - Maria Sessa
- Centro Provinciale Sclerosi Multipla, ASST papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rovaris
- MS Center, Scientific Institute Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Franco Di Palma
- SM Center Neurology Department, ASST Lariana S. Anna Hospital, Como, Italy
| | - Maurizia Gatto
- Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | | | - Augusto Rini
- Centro Sclerosi Multipla, Ospedale A. Perrino, Brindisi, Italy
| | - Giuseppe Meucci
- Ambulatorio Sclerosi MultiplaUnita' Operativa di Neurologia e Neurofisiopatologia, Spedali Riuniti di Livorno, Livorno, Italy
| | - Bonaventura Ardito
- Centro Sclerosi Mutipla UOC di Neurologia, Ospedale Della Murgia Fabio Perinei, Altamura, Italy
| | - Paola Banfi
- Dipartimento di Neurologia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Davide Nasuelli
- ASST Della Valle Olona Presidio Ospedaliero di Saronno Ambulatorio Sclerosi Multipla, Saronno, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria Assunta Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Clara Grazia Chisari
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Giuseppe Fenu
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Marco Onofrj
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Massimo Filippi
- Neurology and Neurorehabilitation Units, Neurophysiology Service, Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, Bari, Italy.
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Vališ M, Achiron A, Hartung HP, Mareš J, Tichá V, Štourač P, Halusková S, Angelucci F, Pavelek Z. The Benefits and Risks of Switching from Fingolimod to Siponimod for the Treatment of Relapsing-Remitting and Secondary Progressive Multiple Sclerosis. Drugs R D 2023; 23:331-338. [PMID: 37640862 PMCID: PMC10676342 DOI: 10.1007/s40268-023-00434-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/31/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic neurodegenerative disease that affects the central nervous system (CNS). Currently, MS treatment is limited to several Food and Drug Administration (FDA)- and European Medicines Agency (EMA)-approved medications that slow disease progression by immunomodulatory action. Fingolimod and siponimod have similar mechanisms of action, and consequently, their therapeutic effects may be comparable. However, while fingolimod is mainly used for relapsing-remitting MS (RRMS), siponimod, according to EMA label, is recommended for active secondary progressive MS (SPMS). Clinicians and scientists are analysing whether patients can switch from fingolimod to siponimod and identifying the advantages or disadvantages of such a switch from a therapeutic point of view. In this review, we aim to discuss the therapeutic effects of these two drugs and the advantages/disadvantages of switching treatment from fingolimod to siponimod in patients with the most common forms of MS, RRMS and SPMS.
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Affiliation(s)
- Martin Vališ
- Department of Neurology, Faculty of Medicine and University Hospital Hradec Králové, Charles University in Prague, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel
- Neurology Department, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hans Peter Hartung
- Department of Neurology, Medical School, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Faculty of Medicine at Palacký University and University Hospital in Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
- Brain and Mind Center, University of Sydney, Sydney, Australia
| | - Jan Mareš
- Department of Neurology, Faculty of Medicine at Palacký University and University Hospital in Olomouc, I. P. Pavlova 6, Olomouc, Czech Republic
| | - Veronika Tichá
- First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Pavel Štourač
- Department of Neurology, Faculty of Medicine and University Hospital Hradec Králové, Charles University in Prague, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Simona Halusková
- Department of Neurology, Faculty of Medicine and University Hospital Hradec Králové, Charles University in Prague, Sokolská 581, 500 05, Hradec Králové, Czech Republic
| | - Francesco Angelucci
- Department of Neurology, Faculty of Medicine and University Hospital Hradec Králové, Charles University in Prague, Sokolská 581, 500 05, Hradec Králové, Czech Republic
- Memory Clinic, Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zbyšek Pavelek
- Department of Neurology, Faculty of Medicine and University Hospital Hradec Králové, Charles University in Prague, Sokolská 581, 500 05, Hradec Králové, Czech Republic.
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