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Publications

Journal Article Ppublish

PubMed: 42085644 DOI: 10.1212/WNL.0000000000214943

Differences in Use of Disease-Modifying Therapies Between Patients With Late-Onset and Adult-Onset Relapsing-Remitting Multiple Sclerosis.

Neurology 106(10):e214943

Authors: Antoine Gavoille, Anne Kerbrat, Gilles Edan, Emmanuelle Le Page, Fabien Rollot, Romain Casey, Guillaume Mathey, Bruno Stankoff, Jonathan Ciron, Jerome De Seze, Aurélie Ruet, Pierre M Labauge, Arnaud Kwiatkowski, Helene Zephir, Caroline Papeix, Gilles Defer, Christine Lebrun-Frenay, Thibault Moreau, Eric Berger, Pierre Clavelou, Eric Thouvenot, Olivier Heinzlef, Jean Pelletier, Abdullatif Al Khedr, Olivier Casez, Bertrand Bourre, Abir Wahab, Thomas David, Laurent Magy, Jean-Philippe Camdessanche, Solène Moulin, Ines Doghri, Mariana Sarov, Amélie Dos Santos, Corinne Pottier, Eric Manchon, Jennifer Aboab, Maya Tchikviladze, Camille Dahan, Pierre Durozard, Clarisse Scherer-Gagou, Alexandre Leclancher, David Axel Laplaud, Sandra Vukusic, Laure Michel

Affiliations

  • Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France.
  • Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Université de Lyon, Université Lyon 1, CNRS, France.
  • Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon.
  • Neurology Department, Rennes University Hospital, France.
  • Clinical Neuroscience Centre, CIC_P1414 INSERM, Rennes, University Hospital, Rennes University, France.
  • Université de Lyon, Université Claude Bernard Lyon 1, France.
  • Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, France.
  • Eugène Devic EDMUS Foundation Against Multiple Sclerosis, Bron Cedex, France.
  • Department of Neurology, Nancy University Hospital, France.
  • Université de Lorraine, Inserm, INSPIIRE, Nancy, France.
  • CHRU de Nancy, Université de Lorraine, Inserm, CIC 1433 EC, Nancy, France.
  • Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Department of Neurology, DMU Neuroscience, AP-HP, Hôpital de la Pitié Salpêtrière, Paris, France.
  • CHU de Toulouse, CRC-SEP, Department of Neurology, Toulouse Cedex 9, France.
  • Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, Toulouse Cedex 3, France.
  • CHU de Strasbourg, Department of Neurology and Clinical Investigation Center, CIC 1434, INSERM 1434, France.
  • Department of Neurology, Service Pathologies inflammatoires du sytème nerveux central, CRC-SEP, University Hospital of Bordeaux, France.
  • INSERM U1215, Neurocentre Magendie, Bordeaux University, France.
  • CHU de Montpellier, MS Unit, Montpellier Cedex 5, France.
  • University of Montpellier (MUSE), France.
  • Department of Neurology, Hôpital Saint Vincent de Paul, Lille, France.
  • CHU Lille, CRCSEP Lille, Univ Lille, U1172, France.
  • Department of Neurology, Fondation Rotschild, Paris, France.
  • CHU de Caen, MS expert centre, Department of Neurology, avenue de la Côte-de-Nacre, Normandy University, Caen, France.
  • Neurology, UR2CA_URRIS, Centre Hospitalier Universitaire Pasteur2, Université Nice Côte d'Azur, France.
  • CHU de Dijon, Department of Neurology, EA4184, France.
  • CHU de Besançon, Service de Neurologie, Besançon, France.
  • CHU Clermont-Ferrand, Department of Neurology, Clermont-Ferrand, France.
  • Université Clermont Auvergne, Inserm, Neuro-Dol, Clermont-Ferrand, France.
  • Department of Neurology, Nimes University Hospital, Nimes Cedex 9, France.
  • IGF, University of Montpellier, CNRS, INSERM, Montpellier Cedex 5, France.
  • Departement of Neurology, Hôpital de Poissy, Poissy, France.
  • Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France.
  • Department of Neurology, CHU d'Amiens, France.
  • Department of Neurology, CHU Grenoble Alpes, Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, La Tronche, France.
  • T-RAIG, TIMC-IMAG, Grenoble Alpes University, France.
  • Departement of Neurology, CHU de Rouen, France.
  • Department of neurology, APHP, Hôpital Henri Mondor, Créteil, France.
  • Department of Neurology, CHU de la Martinique, Fort-de-France, France.
  • Department of Neurology, CHU de Limoges, Hôpital Dupuytren, Limoges, France.
  • Department of Neurology, CHU de Saint-Étienne, Hôpital Nord, Saint-Étienne, France.
  • Department of neurology, CHU de Reims, CRC-SEP, Reims cedex, France.
  • CHU de Tours, Hôpital Bretonneau, CRC SEP and Department of neurology, France.
  • Department of Neurology, APHP, Hôpital Kremlin Bicêtre, Le Kremlin Bicêtre, France.
  • CHU La Milétrie, Hôpital Jean Bernard, Department of neurology et Centre d'Investigation Clinique, CIC INSERM 1402, Poitiers, France.
  • Department of Neurology, CH de Pontoise, Hôpital René Dubos, France.
  • Department of Neurology, CH de Gonesse, Gonesse, France.
  • Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
  • Department of neurology, Hôpital Foch, Suresnes, France.
  • Departement of Neurology, CH de Pau, France.
  • CH d'Ajaccio, CRC SEP, France.
  • Departement of Neurology, CHU Angers, France.
  • Department of Neurology, GHH Du Havre, Le Havre, France; and.
  • Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, CIC INSERM 1413, Service de Neurologie, Nantes, France.

Abstract

BACKGROUND AND OBJECTIVES

The therapeutic strategy for late-onset multiple sclerosis (LOMS) with a relapsing-remitting onset remains unclear, potentially leading to underexposure to disease-modifying therapies (DMTs) compared with adult-onset multiple sclerosis (AOMS). We investigated the differences in DMT use between LOMS and AOMS within the French MS registry at comparable levels of disease severity.

METHODS

This retrospective cohort study used data extracted in December 2024 from the French MS registry on patients with relapsing-remitting onset MS between 1997 and 2023. The primary outcome was the annual probability of receiving a DMT according to age at MS onset, adjusted for disease severity. Secondary outcomes included the annual probability of receiving a highly effective DMT (HEDMT), each DMT separately, having ≥1 EDSS measurement, having ≥1 brain MRI, and DMT initiations and discontinuations. We used a longitudinal logistic model with generalized estimating equations and an inverse-probability-of-censoring weighting.

RESULTS

A total of 36,148 were included patients; 26,540 (73.4%) were female, mean age was 33.5 years (SD, 9.7), and 2,308 (6.4%) were aged ≥50 at disease onset. Median follow-up was 10.8 years (interquartile range, 5.6-17.0). Patients with LOMS had a lower annual probability of receiving a DMT compared with patients with AOMS (73.7% vs 83.1%; odds ratio [OR], 0.57 [95% CI 0.52-0.62]). The difference was greater for HEDMT (24.6% vs 44.4%; OR, 0.41 [95% CI 0.36-0.46]). Patients with LOMS were more likely to receive teriflunomide and less likely to receive fumarates, S1PR modulators, natalizumab, or anti-CD20. Clinical and radiologic follow-up did not differ significantly between patients with LOMS and AOMS. The rate of DMT initiation was lower in patients with LOMS (0.13 vs 0.17 initiation per patient-year). Although the proportions of DMT discontinuation were similar (59.7% vs 60.4%, excluding pregnancy-related discontinuations), these discontinuations were more often attributed to a complete discontinuation strategy (27.9% vs 22.3%) and less often to an escalation strategy (9.2% vs 13.8%) in patients with LOMS.

DISCUSSION

At comparable levels of disease severity, patients with LOMS were less likely to be treated with DMTs, particularly HEDMT, than patients with AOMS. This gap was driven both by fewer DMT initiations and more frequent complete discontinuations.

MeSH

Registries, Sclerosis, Multiple Sclerosis, Probability, Therapeutics, Neurology, Multiple Sclerosis, Relapsing-Remitting