Contributions
Abstract: EP1667
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Introduction: The long-term impact of Disease Modifying Treatments (DMTs) for people with Relapsing Remitting Multiple Sclerosis (pwRRMS) remains poorly characterised. Published data suggest considerable variation in DMT use, but suffer from numerous sources of bias. By identifying patients with similar disease severity in Scotland who are treated differently, MODERATE aims to compare outcomes in patients with and without DMTs, using Propensity Score Matching (PSM) to account for indication bias.
Methods: The Scottish Multiple Sclerosis Register was used to identify all pwRRMS diagnosed in 2010-2011 in 2 regional centres. PSM was used to identify DMT treated and untreated subjects with similar baseline characteristics. Nine covariates were used to calculate propensity scores for DMT initiation: age, gender, ethnicity, disease duration, initial relapse symptoms, number of relapses, first inter-attack interval and number of MRI lesions. Calliper distance was 0.2 for matching. Retrospective outcomes were collected, comparing pwRRMS who started a DMT within 1 year and remained on treatment versus pwRRMS never treated over 4 years.
Results: After exclusions for incomplete data, 245 patients were identified. 130(53%) had DMT started within one year of diagnosis, while 115(47%) did not. There was considerable overlap in propensity scores: 41% of untreated and 58% of treated pwRRMS were within the middle two quartiles for the whole cohort. PSM identified 62 matched pairs with similar disease severity at diagnosis, one of whom was treated and one of whom was untreated within 1 year of diagnosis.
Detection bias and missing data influenced outcome assessments, with treated patients being reviewed more frequently. Over 3 years, mean relapse number and severity in the treated and never treated group (39 pairs) showed no significant differences and 17.9%(treated) vs. 10.3%(untreated) pwRRMS had documented disability worsening. Over 5 years, 17.9% of the treated group and 5.1% of the never treated group were diagnosed with progressive disease (p=0.07).
Conclusions: The initial decision to treat approximately half (124/245) of pwRRMS with DMTs in Scotland depends on factors unrelated to their disease or demographics. Propensity matched pairs have been generated for detailed outcome assessments evaluating the effects of DMT initiation and escalation. Initial retrospective analysis of the effect of early DMT initiation on disability has not demonstrated benefit over 5 years.
Disclosure: Paul Gallagher has received research funding from Sanofi Genzyme as well as travel grants from this company, Novartis and Biogen
Mario Hair: Nothing to disclose
Angus Macleod: Funding from Chief Scientist Office of the Scottish Government, Parkinson´s UK, Academy of Medical Sciences, Wellcome Trust, University of Aberdeen, and NHS Grampian Endowments. No conflicts of interest
James Overell has received honoraria for speaking engagements and attendance at advisory boards from Teva, Novartis, Merck-Serono, Genzyme, Roche, Allergan and Biogen. Additionally his department has received educational grants, research funding and funds to provide nursing and administrative staff from these companies.
Abstract: EP1667
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Introduction: The long-term impact of Disease Modifying Treatments (DMTs) for people with Relapsing Remitting Multiple Sclerosis (pwRRMS) remains poorly characterised. Published data suggest considerable variation in DMT use, but suffer from numerous sources of bias. By identifying patients with similar disease severity in Scotland who are treated differently, MODERATE aims to compare outcomes in patients with and without DMTs, using Propensity Score Matching (PSM) to account for indication bias.
Methods: The Scottish Multiple Sclerosis Register was used to identify all pwRRMS diagnosed in 2010-2011 in 2 regional centres. PSM was used to identify DMT treated and untreated subjects with similar baseline characteristics. Nine covariates were used to calculate propensity scores for DMT initiation: age, gender, ethnicity, disease duration, initial relapse symptoms, number of relapses, first inter-attack interval and number of MRI lesions. Calliper distance was 0.2 for matching. Retrospective outcomes were collected, comparing pwRRMS who started a DMT within 1 year and remained on treatment versus pwRRMS never treated over 4 years.
Results: After exclusions for incomplete data, 245 patients were identified. 130(53%) had DMT started within one year of diagnosis, while 115(47%) did not. There was considerable overlap in propensity scores: 41% of untreated and 58% of treated pwRRMS were within the middle two quartiles for the whole cohort. PSM identified 62 matched pairs with similar disease severity at diagnosis, one of whom was treated and one of whom was untreated within 1 year of diagnosis.
Detection bias and missing data influenced outcome assessments, with treated patients being reviewed more frequently. Over 3 years, mean relapse number and severity in the treated and never treated group (39 pairs) showed no significant differences and 17.9%(treated) vs. 10.3%(untreated) pwRRMS had documented disability worsening. Over 5 years, 17.9% of the treated group and 5.1% of the never treated group were diagnosed with progressive disease (p=0.07).
Conclusions: The initial decision to treat approximately half (124/245) of pwRRMS with DMTs in Scotland depends on factors unrelated to their disease or demographics. Propensity matched pairs have been generated for detailed outcome assessments evaluating the effects of DMT initiation and escalation. Initial retrospective analysis of the effect of early DMT initiation on disability has not demonstrated benefit over 5 years.
Disclosure: Paul Gallagher has received research funding from Sanofi Genzyme as well as travel grants from this company, Novartis and Biogen
Mario Hair: Nothing to disclose
Angus Macleod: Funding from Chief Scientist Office of the Scottish Government, Parkinson´s UK, Academy of Medical Sciences, Wellcome Trust, University of Aberdeen, and NHS Grampian Endowments. No conflicts of interest
James Overell has received honoraria for speaking engagements and attendance at advisory boards from Teva, Novartis, Merck-Serono, Genzyme, Roche, Allergan and Biogen. Additionally his department has received educational grants, research funding and funds to provide nursing and administrative staff from these companies.