Evidence map›Paper›PMID 38688877›Full record

ArticleBrain and behavior2024

Escalating to medium- versus high-efficacy disease modifying therapy after low-efficacy treatment in relapsing remitting multiple sclerosis.

Jannis Müller, Izanne Roos, Tomas Kalincik, Johannes Lorscheider, Edoardo Galli, Pascal Benkert, Sabine Schädelin, Sifat Sharmin, Maximilian Einsiedler, Peter Hänni and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Brain and behavior, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Jannis MüllerNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0003-1394-8231
Izanne RoosCORe, Department of Medicine, University of Melbourne, Melbourne, Australia.
Tomas KalincikCORe, Department of Medicine, University of Melbourne, Melbourne, Australia.
Johannes LorscheiderNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
Edoardo GalliNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.ORCID 0000-0002-9760-2643
Pascal BenkertDepartment of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland.
Sabine SchädelinDepartment of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland.
Sifat SharminCORe, Department of Medicine, University of Melbourne, Melbourne, Australia.
Maximilian EinsiedlerNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
Peter HänniSwiss Federation for Common Tasks of Health Insurances (SVK), Solothurn, Switzerland.
Jürg SchmidSwiss Federation for Common Tasks of Health Insurances (SVK), Solothurn, Switzerland.
Jens KuhleNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
Tobias DerfussNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
Cristina GranzieraNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
Tjalf ZiemssenDivision of Health Care Sciences, Dresden International University, Dresden, Germany.
Timo SiepmannDivision of Health Care Sciences, Dresden International University, Dresden, Germany.
Özgür YaldizliNeurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn patients with relapsing remitting multiple sclerosis (RRMS) on low-efficacy disease modifying therapies (DMT), the optimal strategy on how to escalate treatment once needed, remains unknown.

methodsWe studied RRMS patients on low-efficacy DMTs listed in the Swiss National Treatment Registry, who underwent escalation to either medium- or high-efficacy DMTs. Propensity score-based matching was applied using 12 clinically relevant variables. Both groups were also separately matched with control subjects who did not escalate therapy. Time to relapse and to disability worsening were evaluated using Cox proportional hazard models.

resultsOf 1037 eligible patients, we 1:1 matched 450 MS patients who switched from low-efficacy to medium-efficacy (n = 225; 76.0% females, aged 42.4 ± 9.9 years [mean ± SD], median EDSS 3.0 [IQR 2-4]) or high-efficacy DMTs (n = 225; 72.4% females, aged 42.2 ± 10.6 years, median EDSS 3.0 [IQR 2-4]). Escalation to high-efficacy DMTs was associated with lower hazards of relapses than medium-efficacy DMTs (HR = 0.67, 95% CI 0.47-0.95, p = .027) or control subjects (HR = 0.61, 95% CI 0.44-0.84, p = .003). By contrast, escalation from low to medium-efficacy DMTs did not alter the hazard for relapses when compared to controls (i.e. patients on low-efficacy DMT who did not escalate DMT during follow-up)

conclusionOur nationwide registry analysis suggests that, once escalation from a low-efficacy DMT is indicated, switching directly to a high-efficacy treatment is superior to a stepwise escalation starting with a moderate-efficacy treatment.

Indexed as

Multiple Sclerosis, Relapsing-RemittingAdultFemaleHumansMaleMiddle AgedRecurrenceRegistriesSwitzerlandTreatment Outcomedisease modifying therapiesearly‐intensiveescalationtreatment selectiontreatment strategies

Identifiers

PMID38688877
PMCPMC11061202

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.