ArticleFrontiers in neurology
Real-world effectiveness of high-efficacy therapies in multiple sclerosis: a propensity score-matched cohort study.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
6 authors.
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Abstract
Background: Effectiveness classification of disease-modifying therapies (DMTs) in MS relies either on head-to-head trials or indirect comparisons of annualized relapse rates (ARR) across studies. Validating efficacy estimates in real-world settings is crucial, particularly as the discussion on the broader use of high-efficacy (HE) DMTs including antibodies, S1P receptor modulators, and cladribine tablets, continues to evolve. Because treatment decisions in clinical practice are individualized and no single DMT is universally preferred, effectiveness assessments are appropriately conducted at the group level. Objective: To evaluate the real-world effectiveness of HE vs. low-efficacy (LE) DMTs at the group level. Methods: A retrospective 1:1 propensity score-matched cohort study was conducted using routine data from MS patients initiating HE or LE DMTs at a German tertiary MS center between 2007 and 2023. Primary outcome was ARR; secondary endpoints were cumulative hazard of relapse, MRI activity, loss of NEDA-3, 3-month confirmed disability progression (CDP), and treatment discontinuation. Results: After matching, 266 datasets were analyzed with a median follow-up of 24 months in the LE DMT group and 43 months in the HE DMT group. ARR was 64% lower with HE DMTs (0.13 vs. 0.37; rate ratio 0.36, 95% -CI: 0.23-0.53; Conclusion: HE DMTs resulted in significantly lower clinical and radiological disease activity than LE DMTs in real-world conditions while showing greater treatment persistence. These findings support the broad use of HE DMTs, while LE DMTs may be reserved for specific indications.
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