ArticleNeurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics2020
Induction Versus Escalation in Multiple Sclerosis: A 10-Year Real World Study.
Article in Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- The relative risk of infection in people with multiple sclerosis using disease-modifying treatment: a systematic review of observational studies.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Pooled it
- Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis.The Cochrane database of systematic reviews · 2023Pooled it
- Ocrelizumab in Early-Stage Relapsing-Remitting Multiple Sclerosis: The Phase IIIb ENSEMBLE 4-Year, Single-Arm, Open-Label Trial.Neurology · 2024Trial
- Analysis of Health-Related Quality of Life in Multiple Sclerosis: A Bayesian Quantile LASSO Approach.Healthcare (Basel, Switzerland) · 2026Article
- Real-world effectiveness and safety of ofatumumab in multiple sclerosis: a longitudinal study integrating clinical, cognitive, and MRI outcomes.Therapeutic advances in neurological disorders · 2026Article
- Comparative Effectiveness of Cladribine and S1P Receptor Modulators in Treatment-Naive Relapsing-Remitting MS.JAMA network open · 2025Article
- De-Escalation Treatment Strategies From Natalizumab in Patients With Relapsing Multiple Sclerosis in Austria.European journal of neurology · 2025Article
- De-escalating and discontinuing disease-modifying therapies in multiple sclerosis.Brain : a journal of neurology · 2025Review
- Clinical characteristics and treatment outcomes in multiple sclerosis patients treated with anti-CD20s who switched to fumarates: a retrospective analysis of a US healthcare claims database.Journal of comparative effectiveness research · 2025Observational
- Long-term efficacy and safety of alemtuzumab in participants with highly active MS: TOPAZ clinical trial and interim analysis of TREAT-MS real-world study.Therapeutic advances in neurological disorders · 2025Article
- Shifts in treatment initiation patterns among newly diagnosed multiple sclerosis patients in Germany: a claims data analysis from 2017 to 2022.Therapeutic advances in neurological disorders · 2025Article
- The Czech National MS Registry (ReMuS): Data trends in multiple sclerosis patients whose first disease-modifying therapies were initiated from 2013 to 2021.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia · 2024Article
- Early intensive versus escalation treatment in patients with relapsing-remitting multiple sclerosis in Austria.Journal of neurology · 2024Observational
- Beyond lines of treatment: embracing early high-efficacy disease-modifying treatments for multiple sclerosis management.Therapeutic advances in neurological disorders · 2024Review
- Disease Modifying Strategies in Multiple Sclerosis: New Rays of Hope to Combat Disability?Current neuropharmacology · 2024Review
- Long-term clinical outcomes in patients with multiple sclerosis who are initiating disease-modifying therapy with natalizumab compared with BRACETD first-line therapies.Therapeutic advances in neurological disorders · 2024Article
- Shifting from the treat-to-target to the early highly effective treatment approach in patients with multiple sclerosis - real-world evidence from Germany.Therapeutic advances in neurological disorders · 2024Article
- Treatment switches of disease-modifying therapies in people with multiple sclerosis: long-term experience from the German MS Registry.Therapeutic advances in neurological disorders · 2024Article
- Treatment algorithms of relapsing multiple sclerosis: an exploration based on the available disease-modifying therapies in China.Therapeutic advances in neurological disorders · 2024Review
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15 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In this independent, multicenter, post-marketing study, we directly compare induction immunosuppression versus escalation strategies on the risk of reaching the disability milestone of Expanded Disability Status Scale (EDSS) ≥ 6.0 over 10 years in previously untreated patients with relapsing-remitting multiple sclerosis. We collected data of patients who started interferon beta (escalation) versus mitoxantrone or cyclophosphamide (induction) as initial treatment. Main eligibility criteria included an EDSS score ≤ 4.0 at treatment start and either ≥ 2 relapses or 1 disabling relapse with evidence of ≥ 1 gadolinium-enhancing lesion at magnetic resonance imaging scan in the pre-treatment year. Since patients were not randomized to treatment group, we performed a propensity score (PS)-based matching procedure to select individuals with homogeneous baseline characteristics. Comparisons were then conducted using Cox models stratified by matched pairs. Overall, 75 and 738 patients started with induction and escalation, respectively. Patients in the induction group were older and more disabled than those in the escalation group (p < 0.05). The PS-matching procedure retained 75 patients per group. In the re-sampled population, a lower proportion of patients reached the outcome after induction (21/75, 28.0%) than escalation (29/75, 38.7%) (hazard ratio = 0.48; p = 0.024). Considering the whole sample, serious adverse events occurred more frequently after induction (8/75, 10.7%) than escalation (18/738, 2.4%) (odds ratio = 3.36, p = 0.015). These findings suggest that, in patients with poor prognostic factors, induction was more effective than escalation in reducing the risk of reaching the disability milestone, albeit with a worse safety profile. Future studies are warranted to explore if newer induction agents may provide a more advantageous long-lasting risk:benefit profile.
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