Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis?
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| Title: | Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis? |
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| Authors: | Bonenfant, J., Bajeux, E., Deburghgraeve, V., Le Page, E., Edan, G., Kerbrat, A. |
| Source: | European Journal of Neurology. Feb2017, Vol. 24 Issue 2, p237-244. 8p. |
| Subjects: | Multiple sclerosis treatment, Immunological adjuvants, Magnetic resonance imaging of the brain, Immunoregulation, Follow-up studies (Medicine), Evidence-based medicine, Therapeutics |
| Abstract: | Background and purpose The benefits of immunomodulatory treatments in secondary progressive multiple sclerosis (SPMS) are unclear, calling into question their continuation. In the present observational study, we investigated the effect of treatment withdrawal on the clinical course of SPMS. Methods We included 100 consecutive patients with SPMS who regularly attended our multiple sclerosis clinic. Inclusion criteria were (i) secondary progressive phenotype for at least 2 years, (ii) immunomodulatory treatment for at least 6 months and (iii) treatment stopped with no plans to switch to another. Clinical and magnetic resonance imaging (MRI) data before and after treatment discontinuation were assessed. Factors associated with relapses and/or MRI activity were identified. Results Mean treatment duration was 60.4 ± 39.3 months, and mean follow-up duration after treatment withdrawal was 62.4 ± 38.4 months. The annualized relapse rate remained stable at 1 and 3 years after treatment withdrawal [0.09, 95% confidence interval (CI), 0.05-0.17 and 0.07, 95% CI, 0.05-0.11, respectively], relative to the 3 years prior to treatment withdrawal (0.12, 95% CI, 0.09-0.16). Sixteen patients experienced a relapse and 19 had a gadolinium-positive MRI scan without relapse during follow-up. A gadolinium-positive MRI scan within the previous 3 years before treatment withdrawal and Expanded Disability Status Scale score of <6 were positively associated with relapse and/or MRI activity after discontinuation ( P = 0.0004 and P = 0.03, respectively). Conclusion In this retrospective study, including a limited number of patients with SPMS, the annualized relapse rate remained stable after treatment withdrawal, relative to before treatment withdrawal. Further prospective studies are needed to confirm this result and provide evidence-based guidelines for daily practice. [ABSTRACT FROM AUTHOR] |
| Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 120810684 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis? – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Bonenfant%2C+J%2E%22">Bonenfant, J.</searchLink><br /><searchLink fieldCode="AR" term="%22Bajeux%2C+E%2E%22">Bajeux, E.</searchLink><br /><searchLink fieldCode="AR" term="%22Deburghgraeve%2C+V%2E%22">Deburghgraeve, V.</searchLink><br /><searchLink fieldCode="AR" term="%22Le+Page%2C+E%2E%22">Le Page, E.</searchLink><br /><searchLink fieldCode="AR" term="%22Edan%2C+G%2E%22">Edan, G.</searchLink><br /><searchLink fieldCode="AR" term="%22Kerbrat%2C+A%2E%22">Kerbrat, A.</searchLink> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Feb2017, Vol. 24 Issue 2, p237-244. 8p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Multiple+sclerosis+treatment%22">Multiple sclerosis treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Immunological+adjuvants%22">Immunological adjuvants</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging+of+the+brain%22">Magnetic resonance imaging of the brain</searchLink><br /><searchLink fieldCode="DE" term="%22Immunoregulation%22">Immunoregulation</searchLink><br /><searchLink fieldCode="DE" term="%22Follow-up+studies+%28Medicine%29%22">Follow-up studies (Medicine)</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence-based+medicine%22">Evidence-based medicine</searchLink><br /><searchLink fieldCode="DE" term="%22Therapeutics%22">Therapeutics</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background and purpose The benefits of immunomodulatory treatments in secondary progressive multiple sclerosis (SPMS) are unclear, calling into question their continuation. In the present observational study, we investigated the effect of treatment withdrawal on the clinical course of SPMS. Methods We included 100 consecutive patients with SPMS who regularly attended our multiple sclerosis clinic. Inclusion criteria were (i) secondary progressive phenotype for at least 2 years, (ii) immunomodulatory treatment for at least 6 months and (iii) treatment stopped with no plans to switch to another. Clinical and magnetic resonance imaging (MRI) data before and after treatment discontinuation were assessed. Factors associated with relapses and/or MRI activity were identified. Results Mean treatment duration was 60.4 ± 39.3 months, and mean follow-up duration after treatment withdrawal was 62.4 ± 38.4 months. The annualized relapse rate remained stable at 1 and 3 years after treatment withdrawal [0.09, 95% confidence interval (CI), 0.05-0.17 and 0.07, 95% CI, 0.05-0.11, respectively], relative to the 3 years prior to treatment withdrawal (0.12, 95% CI, 0.09-0.16). Sixteen patients experienced a relapse and 19 had a gadolinium-positive MRI scan without relapse during follow-up. A gadolinium-positive MRI scan within the previous 3 years before treatment withdrawal and Expanded Disability Status Scale score of <6 were positively associated with relapse and/or MRI activity after discontinuation ( P = 0.0004 and P = 0.03, respectively). Conclusion In this retrospective study, including a limited number of patients with SPMS, the annualized relapse rate remained stable after treatment withdrawal, relative to before treatment withdrawal. Further prospective studies are needed to confirm this result and provide evidence-based guidelines for daily practice. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/ene.13181 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 8 StartPage: 237 Subjects: – SubjectFull: Multiple sclerosis treatment Type: general – SubjectFull: Immunological adjuvants Type: general – SubjectFull: Magnetic resonance imaging of the brain Type: general – SubjectFull: Immunoregulation Type: general – SubjectFull: Follow-up studies (Medicine) Type: general – SubjectFull: Evidence-based medicine Type: general – SubjectFull: Therapeutics Type: general Titles: – TitleFull: Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis? Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Bonenfant, J. – PersonEntity: Name: NameFull: Bajeux, E. – PersonEntity: Name: NameFull: Deburghgraeve, V. – PersonEntity: Name: NameFull: Le Page, E. – PersonEntity: Name: NameFull: Edan, G. – PersonEntity: Name: NameFull: Kerbrat, A. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 02 Text: Feb2017 Type: published Y: 2017 Identifiers: – Type: issn-print Value: 13515101 Numbering: – Type: volume Value: 24 – Type: issue Value: 2 Titles: – TitleFull: European Journal of Neurology Type: main |
| ResultId | 1 |
