Improving the decision to switch from first- to second-line therapy in multiple sclerosis: A dynamic scoring system

Camille Sabathé (1) , Romain Casey , Sandra Vukusic , Emmanuelle Leray (2, 3, 4, 5, 6) , Guillaume Mathey , Jérôme de Sèze , Bruno Stankoff , Jonathan Ciron , Sandrine Wiertlewski , Aurélie Ruet , Christine Lebrun-Frenay , Jean Pelletier (7, 8) , Hélène Zéphir , Laure Michel , Xavier Moisset , Elisabeth Maillart , Serge Bakchine , Eric Thouvenot , Abdullatif Al Khedr , Jean-Philippe Camdessanché , Karolina Hankiewicz , Philippe Cabre , Eric Berger , Olivier Heinzlef , Gilles Defer , Thibault Moreau , Olivier Gout , Bertrand Bourre , Abir Wahab , Pierre Labauge , David-Axel Laplaud , Alexis Montcuquet , Olivier Casez , Aude Maurousset , Nicolas Maubeuge , Dalia Dimitri Boulos , Haïfa Ben Nasr , Chantal Nifle , Yohann Foucher

1 Université de Nantes, Université de Tours, Inserm, UMR1246 Sphere, Nantes
2 CIC - Centre d'Investigation Clinique [Rennes]
3 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
4 METIS - Département Méthodes quantitatives en santé publique
5 EHESP - École des Hautes Études en Santé Publique [EHESP]
6 RSMS - Recherche sur les services et le management en santé
7 Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
8 CRMBM-CEMEREM - Aix Marseille Univ, UMR 7339 CNRS, Centre de Résonance Magnétique Biologique et Médicale,

Background: In relapsing-remitting multiple sclerosis (RRMS), early identification of suboptimal responders can prevent disability progression. Objective: We aimed to develop and validate a dynamic score to guide the early decision to switch from first- to second-line therapy. Methods: Using time-dependent propensity scores (PS) from a French cohort of 12,823 patients with RRMS, we constructed one training and two validation PS-matched cohorts to compare the switched patients to second-line treatment and the maintained patients. We used a frailty Cox model for predicting individual hazard ratios (iHRs). Results: From the validation PS-matched cohort of 348 independent patients with iHR ⩽ 0.69, we reported the 5-year relapse-free survival at 0.14 (95% confidence interval (CI) 0.09–0.22) for the waiting group and 0.40 (95% CI 0.32–0.51) for the switched group. From the validation PS-matched cohort of 518 independent patients with iHR > 0.69, these values were 0.37 (95% CI 0.30–0.46) and 0.44 (95% CI 0.37–0.52), respectively. Conclusions: By using the proposed dynamic score, we estimated that at least one-third of patients could benefit from an earlier switch to prevent relapse.

Keywords: Epidemiology; Multiple sclerosis; Second-line treatment; Treatment response

Domains: Life Sciences [q-bio]; Human health and pathology

Camille Sabathé, Romain Casey, Sandra Vukusic, Emmanuelle Leray, Guillaume Mathey, et al.. Improving the decision to switch from first- to second-line therapy in multiple sclerosis: A dynamic scoring system. Multiple Sclerosis Journal, 2023, 29 (2), pp.236-247. ⟨10.1177/13524585221139156⟩. ⟨hal-03963620⟩