An analysis of data from 24 Italian MS centres has identified factors associated with an early change of disease-modifying therapy (Sacca et al. Mult Scler 2018; epublished July 25, 2018).
Total enrolment was 3025 patients. Overall, 48% of patients switched treatments in the first three years of starting a DMT. Factors associated with an early switch due to lack of efficacy included the presence of spinal cord lesions (hazard ratio 1.46), diagnostic delay (HR 1.23), and higher baseline EDSS score (HR1.17). Switching due to lack of efficacy was less likely with natalizumab (HR 0.13), teriflunomide (HR 0.21), fingolimod (HR 0.50), and dimethyl fumarate (HR 0.60) compared to an interferon.
Switching due to intolerance or safety considerations was less common with fingolimod (HR 0.35), dimethyl fumarate (HR 0.57) and glatiramer acetate (HR 0.61) compared to an interferon. Switching due to intolerance/safety was more common in patients with comorbidities (HR 1.28) and those on natalizumab (HR 1.43).