High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS
- Type de publi. : Article dans une revue
- Date de publi. : 25/03/2024
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Auteurs :
Guillaume JouvenotGuilhem CourbonMathilde LefortFabien RollotRomain CaseyEmmanuelle Le PageLaure MichelGilles EdanJérôme de SèzeLaurent KremerKevin BigautSandra VukusicGuillaume MatheyJonathan CironAurélie RuetElisabeth MaillartPierre LabaugeHélène ZéphirCaroline PapeixGilles DeferChristine Lebrun-FrénayThibault MoreauDavid-Axel LaplaudEric BergerBruno StankoffPierre ClavelouEric ThouvenotOlivier HeinzlefJean PelletierAbdullatif Al-KhedrOlivier CasezBertrand BourrePhilippe CabreAbir WahabLaurent MagyJean-Philippe CamdessanchéInes DoghriSolène MoulinHaifa Ben-NasrCéline LabeyrieKarolina HankiewiczJean-Philippe NeauCorinne PottierChantal NifleNicolas CollonguesAnne KerbratFrançois CottonPascal DouekFrancis GuillememinAlexandre PachotJavier OlaizClaire Rigaud-BullyRomain MarignierMarc DebouverieCatherine LubetzkiMikael CohenAgnès FromontSandrine WiertlewskyBertrand AudoinClaire GiannesiniOlivier GoutAlexis MontcuquetSerge BakchineAude MauroussetNicolas Maubeuge
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Organismes :
CIC Strasbourg
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Arènes: politique, santé publique, environnement, médias
Recherche sur les services et le management en santé
École des Hautes Études en Santé Publique
Département Méthodes quantitatives en santé publique
Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
Fondation Eugène Devic EDMUS
Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
Fondation Eugène Devic EDMUS
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Centre d'Investigation Clinique [Rennes]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Centre d'Investigation Clinique [Rennes]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Centre d'Investigation Clinique [Rennes]
CIC Strasbourg
Service de Neurologie [Strasbourg]
Service de Neurologie [Strasbourg]
Service de Neurologie [Strasbourg]
Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
Fondation Eugène Devic EDMUS
Service de neurologie [CHRU Nancy]
INterdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes
Centre Ressources et Compétences sclérose en plaques (CRC-SEP) [CHU Toulouse]
CIC Bordeaux
Service de neurologie [Bordeaux]
CHU Pitié-Salpêtrière [AP-HP]
CHU Montpellier = Montpellier University Hospital
Centre de Ressources et de Compétences sur la Sclérose en Plaques (CRC-SEP) [Lille]
Hôpital Fondation Adolphe de Rothschild = Adolphe de Rothschild Foundation Hospital
Service de Neurologie [CHU Caen]
Unité de Recherche Clinique Côte d’Azur
Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon)
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
CIC Plurithématique de Nantes
Service de Neurologie [CHRU Besançon]
CHU Saint-Antoine [AP-HP]
Service Neurologie [CHU Clermont-Ferrand]
Service de Neurologie [CHU Nimes]
Centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye - CHIPS [Poissy]
Hôpital de la Timone [CHU - APHM]
Service de neurologie [Amiens]
Centre Hospitalier Universitaire [CHU Grenoble]
Service de neurologie [Rouen]
Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
Hôpital Henri Mondor
Hôpital Dupuytren [CHU Limoges]
Service de Neurologie [CHU de Saint-Étienne]
Hôpital Bretonneau
Service de neurologie [Reims]
Centre Hospitalier Sud Francilien
Service de neurologie [Le Kremlin Bicêtre]
Centre Hospitalier de Saint-Denis [Ile-de-France]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
Centre Hospitalier René Dubos [Pontoise]
Centre Hospitalier de Versailles André Mignot
CIC Strasbourg
Service de Neurologie [Strasbourg]
Neuroimagerie: méthodes et applications
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Centre d'Investigation Clinique [Rennes]
Centre Hospitalier Lyon Sud [CHU - HCL]
Centre d'investigation clinique [Nancy]
Centre Hospitalier Lyon Sud [CHU - HCL]
Lyon Ingénierie Projets
Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
Centre Hospitalier Lyon Sud [CHU - HCL]
Centre Hospitalier Régional Universitaire de Nancy
CHU Pitié-Salpêtrière [AP-HP]
CHU Nice [Cimiez]
Service de neurochirurgie [CHU Dijon]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
Centre de résonance magnétique biologique et médicale
CHU Pitié-Salpêtrière [AP-HP]
Hôpital Fondation Adolphe de Rothschild = Adolphe de Rothschild Foundation Hospital
Centre Hospitalier de Brive-la-Gaillarde
Hôpital universitaire Robert Debré [Reims]
Centre Hospitalier Régional Universitaire de Tours
Service de Neurochirurgie [CHU de Poitiers]
- Publié dans JAMA neurology le 24/10/2020
Résumé : Importance: A recent randomized clinical trial concluded that discontinuing medium-efficacy therapy might be a reasonable option for older patients with nonactive multiple sclerosis (MS), but there is a lack of data on discontinuing high-efficacy therapy (HET). In younger patients, the discontinuation of natalizumab and fingolimod is associated with a risk of rebound of disease activity.Objective: To determine whether discontinuing HET in patients 50 years and older with nonactive MS is associated with an increased risk of relapse compared with continuing HET.Design, setting, and participants: This observational cohort study used data from 38 referral centers from the French MS registry (Observatoire Français de la Sclérose en Plaques [OFSEP] database). Among 84704 patients in the database, data were extracted for 1857 patients 50 years and older with relapsing-remitting MS treated by HET and with no relapse or magnetic resonance imaging activity for at least 2 years. After verification of the medical records, 1620 patients were classified as having discontinued HET or having remained taking treatment and were matched 1:1 using a dynamic propensity score (including age, sex, disease phenotype, disability, treatment of interest, and time since last inflammatory activity). Patients were included from February 2008 to November 2021, with a mean (SD) follow-up of 5.1 (2.9) years. Data were extracted in June 2022.Exposures: Natalizumab, fingolimod, rituximab, and ocrelizumab.Main outcomes and measures: Time to first relapse.Results: Of 1620 included patients, 1175 (72.5%) were female, and the mean (SD) age was 54.7 (4.8) years. Among the 1452 in the HET continuation group and 168 in the HET discontinuation group, 154 patients in each group were matched using propensity scores (mean [SD] age, 57.7 [5.5] years; mean [SD] delay since the last inflammatory activity, 5.6 [3.8] years; mean [SD] follow-up duration after propensity score matching, 2.5 [2.1] years). Time to first relapse was significantly reduced in the HET discontinuation group compared with the HET continuation group (hazard ratio, 4.1; 95% CI, 2.0-8.5; P < .001) but differed between HETs, with a hazard ratio of 7.2 (95% CI, 2.1-24.5; P = .001) for natalizumab, 4.5 (95% CI, 1.3-15.5; P = .02) for fingolimod, and 1.1 (95% CI, 0.3-4.8; P = .85) for anti-CD20 therapy.Conclusion and relevance: As in younger patients, in patients 50 years and older with nonactive MS, the risk of relapse increased significantly after stopping HETs that impact immune cell trafficking (natalizumab and fingolimod). There was no significant increase in risk after stopping HETs that deplete B-cells (anti-CD20 therapy). This result may inform decisions about stopping HETs in clinical practice.
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