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Abstract Details

Higher Efficacy Therapies Appear to have a Disproportionately Larger Effect in Younger Patients with Multiple Sclerosis
Multiple Sclerosis
S6 - MS and CNS Inflammatory Disease: Clinical Considerations I (1:44 PM-1:55 PM)
005

Our previous studies demonstrated higher effectiveness with infusible DMTs (rituximab, natalizumab) over oral DMTs (fingolimod, dimethyl fumarate), however, many patients do well on oral DMTs. Identifying patients likely to experience disease activity in clinical practice is still a challenge.

Identify baseline characteristics associated with future disease activity in multiple sclerosis(MS) patients comparing oral and infusible disease modifying therapies(DMTs).
Relapsing-remitting MS Patients prescribed fingolimod, dimethyl fumarate, natalizumab or rituximab at the Rocky Mountain MS Center at the University of Colorado were followed for 24 months or until drug discontinuation. Patients receiving oral (fingolimod, dimethyl fumarate) versus infusible (natalizumab, rituximab) were evaluated for disease activity, defined as experiencing a clinical relapse, new T2 lesion and/or gadolinium enhancing lesion(GdE). 

Of the 1004 patients analyzed, 509 received oral DMTs and 495 received infusible DMTs. In the oral DMT group, 36.4% experienced disease activity versus 21.2% in the infusible DMT group. Oral patients experiencing disease activity were younger(p<0.001), had lower disease duration(p=0.010) and were more likely to have GdE on baseline MRI(p=0.015) than those who did not experience disease activity. Those <45 years had greater odds of experiencing disease activity overall(OR=2.06,p<0.001), clinical relapse(OR=2.20,p=0.008), new T2 lesion(OR=2.95,p<0.001), or GdE(OR=3.35,p<0.001) compared to those ≥45 years. Infusible patients experiencing disease activity were younger(p=0.021) and were more likely to have GdE on baseline MRI(p=0.036). Those <45 years had similar odds of experiencing disease activity overall(OR=1.35,p=0.232), clinical relapse(OR=1.16,p=0.726), new T2 lesion(OR=1.02,p=0.952), or GdE(OR=2.662,p=0.2013) compared to those ≥45 years. The odds of experiencing disease activity with oral versus infusible DMTs is greater in younger patients (<45 years:OR=2.67,p<0.001) than older patients (≥45 years:OR=1.75,p=0.033).
Future disease activity is independently associated with younger patients and GdE lesions at baseline. There is a benefit to treating patients ≥45 years of age. Higher efficacy therapies appear to have a disproportionately larger effect on younger patients.
Authors/Disclosures
Brandi L. Vollmer, MPH (Columbia University, Anschutz Medical Campus)
PRESENTER 		Ms. Vollmer has nothing to disclose.
Kavita Nair, PhD, FAAN (University of Colorado) Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Meyers Squibb. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PhRMA Foundation. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MJH Lifesciences. Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Anylam . Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Applied Patient Experience. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi-Genzyme. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for ICER. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Phrma Foundation. The institution of Dr. Nair has received research support from Bristol Meyers Squibb. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from NINDS. The institution of Dr. Nair has received research support from Sanofi Genzyme. The institution of Dr. Nair has received research support from Kyverna Therapeutcis. Dr. Nair has a non-compensated relationship as a Board Member with Center for Improving Value in Healthcare that is relevant to AAN interests or activities.
Stefan Sillau Stefan Sillau has nothing to disclose.
Timothy L. Vollmer, MD, FAAN The institution of Dr. Vollmer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen IDEC. The institution of Dr. Vollmer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech/Roche. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Siranax. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Meyers Squib. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viela Bios. The institution of Dr. Vollmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. The institution of Dr. Vollmer has received research support from Rocky Mountain MS Center. The institution of Dr. Vollmer has received research support from Biogen. The institution of Dr. Vollmer has received research support from Actelion. The institution of Dr. Vollmer has received research support from Genentech/Roche. The institution of Dr. Vollmer has received research support from Anokion. The institution of Dr. Vollmer has received research support from TG Therapeutics.
John Corboy, MD, FAAN (U of Colorado School of Medicine) Dr. Corboy has received personal compensation for serving as an employee of U of Coloado. Dr. Corboy has received personal compensation for serving as an employee of Rocky Mountain MS Center. Dr. Corboy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mylan. Dr. Corboy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squib. Dr. Corboy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Corboy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Neurological Association. Dr. Corboy has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Mylan. The institution of Dr. Corboy has received research support from MedDay. The institution of Dr. Corboy has received research support from Novartis. The institution of Dr. Corboy has received research support from NMSS. The institution of Dr. Corboy has received research support from PCORI. The institution of Dr. Corboy has received research support from EMD Serono.
Enrique Alvarez, MD, PhD (University of Colorado) Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon.