Treatment persistence and clinical outcomes in patients starting B cell depleting therapies within the Swiss MS Cohort.
Giulio Disanto, Sabine Schaedelin, Johanna Oechtering, Johannes Lorscheider, Riccardo Galbusera, Sebastian Finkener, Lutz Achtnichts, Patrice Lalive, Stefanie Müller, Caroline Pot, Robert Hoepner, Anke Salmen, Chiara Zecca, Lars G Hemkens, Marcus D'Souza, Bettina Fischer-Barnicol, Renaud Du Pasquier, Patrick Roth, Özgür Yaldizli, Maximilian Einsiedler, Tobias Derfuss, Ludwig Kappos, Claudio Gobbi, Cristina Granziera, Marjolaine Uginet, Aleksandra Maleska Maceski, Keltie McDonald, David Leppert, Pascal Benkert, Jens Kuhle, Swiss MS Cohort Study
Author Information
Giulio Disanto: Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland. ORCID
Sabine Schaedelin: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Johanna Oechtering: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Johannes Lorscheider: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Riccardo Galbusera: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Sebastian Finkener: Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Lutz Achtnichts: Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.
Patrice Lalive: Department of Clinical Neurosciences, Division of Neurology, Unit of Neuroimmunology, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland.
Stefanie Müller: Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
Caroline Pot: Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland. ORCID
Robert Hoepner: Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
Anke Salmen: Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland.
Chiara Zecca: Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland. ORCID
Lars G Hemkens: Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital and University of Basel, Basel, Switzerland.
Marcus D'Souza: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Bettina Fischer-Barnicol: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Renaud Du Pasquier: Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Patrick Roth: Department of Neurology, University Hospital Zurich and University of Zurich, Zürich, Switzerland.
Özgür Yaldizli: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Maximilian Einsiedler: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Tobias Derfuss: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Ludwig Kappos: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Claudio Gobbi: Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland. ORCID
Cristina Granziera: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Marjolaine Uginet: Department of Clinical Neurosciences, Division of Neurology, Unit of Neuroimmunology, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland.
Aleksandra Maleska Maceski: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
David Leppert: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Pascal Benkert: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland. ORCID
Jens Kuhle: Neurology, Multiple Sclerosis Center, Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
Background: Persistence to B cell depleting therapies (BCDT) like ocrelizumab and rituximab may be higher compared with other disease-modifying therapies (DMT) in multiple sclerosis (MS). Clinical trials directly comparing these treatments are lacking. Objective: To compare the risk of treatment discontinuation, relapse, and confirmed disability worsening in patients starting BCDT vs other DMT within real-world settings. Methods: In a longitudinal cohort study, patients with relapsing MS starting BCDT (ocrelizumab/rituximab, = 269) after enrolment into the Swiss MS Cohort (SMSC) were evaluated for treatment discontinuation, occurrence of relapses, and disability worsening in comparison with platform ( = 57) and oral ( = 454) DMT, or natalizumab ( = 73) using Cox regression with double robust adjustment for baseline covariates. Results: Patients starting BCDT were less likely to discontinue treatment than all other DMT combined (HR = 0.26, 95% CI = 0.18-0.36, < .01), oral DMT (HR = 0.28, 95% CI = 0.20-0.39, < .01) and natalizumab (HR = 0.35, 95% CI = 0.21-0.58, < .01). BCDT were associated with lower risk of relapses as compared to oral DMT HR = 0.59, 95% CI = 0.39-0.88, < .01), but not to natalizumab (HR = 0.90, 95% CI = 0.45-1.82, = .778). Disability worsening was not significantly different between treatment groups. Conclusion: We provide real-world evidence for patients being more persistent to BCDT than to other treatments, and better clinical outcomes may partly explain this.
