Characteristics influencing therapy switch behavior after suboptimal response to first-line treatment in patients with multiple sclerosis

This retrospective study from the US looked at patients with RRMS who had a sub-optimal response (patients with ≥1 MS event-clinical relapse, worsening disability or MRI worsening) to either interferon β or glatiramer acetate. They defined switchers as those who changed disease-modifying therapy (DMT) within 6-12 months after the MS event. 35.3% of suboptimal responders changed therapy.

They found that switchers tended to be younger at symptom onset, MS diagnosis, DMT initiation and first MS event when compared to those who did not switch. MRI activity alone was a very strong predictor of switch behaviour, which was followed by ≥2 relapses, EDSS plus MRI worsening and EDSS worsening alone.

This is interesting as some treatment guidelines suggest less weight should be given to MRI worsening when considering therapy change. Therefore, patients experiencing worsening of their MS are more likely to switch therapy if younger. This suggests that MRI worsening may drive therapy switch decisions to a greater extent than relapse or disability worsening.

Authors:Teter B, Agashivala N
Source: Mult Scler. 2013 Nov 25. [Epub ahead of print]
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