Contributions
Abstract: EP1374
Type: ePoster
Abstract Category: Clinical aspects of MS - MS and gender
Background: Numerous and more effective treatment options have become available in the management of multiple sclerosis (MS). Clinical and economical considerations as well as expertise with different drugs gained over time may further drive treatment decisions in clinical practice. However, little is known about the interaction of gender and the usage of highly active therapies in real-life.
Objectives: To study temporal trends and gender differences related to the initiation of escalation therapy in MS patients.
Methods: We analysed the group of MS patients who underwent treatment escalation with natalizumab, fingolimod and alemtuzumab in the period from 2007 to 2015 at our tertiary care centre. We studied the correlations between clinical, demographic parameters and study year. In multiple regression analyses, we included the interaction term of gender and study year to assess whether temporal dynamics of those parameters differed across males and females.
Results: In total, 139 patients (60.4% women, mean age 41 years [19-74]) were treated either with natalizumab (n=80), fingolimod (n=51), or alemtuzumab (n=8), over the study period. Mean duration of therapy prior to escalation was 10.8 years in women and 10.2 years in men (SD 6.8 and 7, respectively). Median EDSS was 2.5 (IQR 3.5), and 3 (IQR 3.1), and median relapse rate 2 (IQR 2), and 1 (IQR 1) in the respective patients. We saw a negative correlation between the year of therapy escalation and duration of treatment prior to escalation (r=-0.43, p< 0.001). Age and EDSS score at the time of escalation, relapse rate during prior 12 months were negatively associated with the year of escalation as well (r=-0.4, r=-0.4, r=-0.37, accordingly, all p< 0.01). We observed a significant interaction between gender and study year in determining the duration of therapy prior to escalation (p for interaction=0.038), which indicated greater decrease in time to escalation among male patients throughout the time. The interaction was not significant in relation to age and EDSS score at escalation, and 12-month relapse rate.
Conclusions: Our study disclosed that treatment escalation in clinical practice undergoes a temporal evolution towards earlier initiation of more effective therapy. The reasons why this trend is more pronounced in men is unclear but could point at a distinct approach towards usage of treatments with an altered benefit-risk balance among sexes and deserves further investigation in larger cohorts.
Disclosure:
Dr. Karamyan: nothing to disclose.
Dr. Oppermann: nothing to disclose.
Dr. Bacher: nothing to disclose.
Dr. Otto: nothing to disclose.
Dr. Pilz: nothing to disclose.
Dr. Wipfler: nothing to disclose.
Dr. Chroust: nothing to disclose.
Dr. Sellner received research funding from the Paracelsus Medical University, Bayer, Biogen-Idec, Merck and Novartis, has acted as paid consultant to Novartis and Genzyme, and has received speakers" honoraria from Biogen-Idec, Ever Neuropharma, Genzyme, Novartis and Teva-Ratiopharm. He has no specific conflicts relevant to this work.
Abstract: EP1374
Type: ePoster
Abstract Category: Clinical aspects of MS - MS and gender
Background: Numerous and more effective treatment options have become available in the management of multiple sclerosis (MS). Clinical and economical considerations as well as expertise with different drugs gained over time may further drive treatment decisions in clinical practice. However, little is known about the interaction of gender and the usage of highly active therapies in real-life.
Objectives: To study temporal trends and gender differences related to the initiation of escalation therapy in MS patients.
Methods: We analysed the group of MS patients who underwent treatment escalation with natalizumab, fingolimod and alemtuzumab in the period from 2007 to 2015 at our tertiary care centre. We studied the correlations between clinical, demographic parameters and study year. In multiple regression analyses, we included the interaction term of gender and study year to assess whether temporal dynamics of those parameters differed across males and females.
Results: In total, 139 patients (60.4% women, mean age 41 years [19-74]) were treated either with natalizumab (n=80), fingolimod (n=51), or alemtuzumab (n=8), over the study period. Mean duration of therapy prior to escalation was 10.8 years in women and 10.2 years in men (SD 6.8 and 7, respectively). Median EDSS was 2.5 (IQR 3.5), and 3 (IQR 3.1), and median relapse rate 2 (IQR 2), and 1 (IQR 1) in the respective patients. We saw a negative correlation between the year of therapy escalation and duration of treatment prior to escalation (r=-0.43, p< 0.001). Age and EDSS score at the time of escalation, relapse rate during prior 12 months were negatively associated with the year of escalation as well (r=-0.4, r=-0.4, r=-0.37, accordingly, all p< 0.01). We observed a significant interaction between gender and study year in determining the duration of therapy prior to escalation (p for interaction=0.038), which indicated greater decrease in time to escalation among male patients throughout the time. The interaction was not significant in relation to age and EDSS score at escalation, and 12-month relapse rate.
Conclusions: Our study disclosed that treatment escalation in clinical practice undergoes a temporal evolution towards earlier initiation of more effective therapy. The reasons why this trend is more pronounced in men is unclear but could point at a distinct approach towards usage of treatments with an altered benefit-risk balance among sexes and deserves further investigation in larger cohorts.
Disclosure:
Dr. Karamyan: nothing to disclose.
Dr. Oppermann: nothing to disclose.
Dr. Bacher: nothing to disclose.
Dr. Otto: nothing to disclose.
Dr. Pilz: nothing to disclose.
Dr. Wipfler: nothing to disclose.
Dr. Chroust: nothing to disclose.
Dr. Sellner received research funding from the Paracelsus Medical University, Bayer, Biogen-Idec, Merck and Novartis, has acted as paid consultant to Novartis and Genzyme, and has received speakers" honoraria from Biogen-Idec, Ever Neuropharma, Genzyme, Novartis and Teva-Ratiopharm. He has no specific conflicts relevant to this work.