Rebound of clinical disease activity after fingolimod discontinuation? A nationwide cohort study of patients in Denmark
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Rebound of clinical disease activity after fingolimod discontinuation? A nationwide cohort study of patients in Denmark. / Framke, Elisabeth; Pontieri, Luigi; Bramow, Stephan; Sellebjerg, Finn; Magyari, Melinda.
In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 93, No. 12, 2022, p. 1317-1321.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Rebound of clinical disease activity after fingolimod discontinuation? A nationwide cohort study of patients in Denmark
AU - Framke, Elisabeth
AU - Pontieri, Luigi
AU - Bramow, Stephan
AU - Sellebjerg, Finn
AU - Magyari, Melinda
N1 - Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Objective We investigated whether clinical rebound occurred after fingolimod discontinuation in a complete population of patients with relapsing-remitting multiple sclerosis (RRMS) in Denmark. We further identified clinical and demographical factors associated with disease reactivation after fingolimod discontinuation. Methods The population comprised 992 RRMS patients treated with fingolimod for 6 months or more. We estimated annualised relapse rates (ARR) before, during and after treatment. We estimated overall ARRs and ARRs stratified by disease activity before discontinuation. We calculated the proportion of patients with a higher clinical disease activity after discontinuation than before treatment start. Finally, we analysed the association between variables at discontinuation and time to first relapse after discontinuation. Results The ARR 3 months after discontinuation (ARR=0.56; 95% CI=0.47 to 0.66) was statistically significantly lower (p<0.01) than the ARR 1 year before treatment (ARR=0.74; 95% CI=0.69 to 0.80). Results were similar when repeating analyses in patients with and without disease activity before discontinuation. In total, 124 patients (12.5%) had clinical rebound. Of those, 36 had no disease breakthrough before discontinuation (3.6% of total population). On treatment disease activity (HR=1.98, p<0.01), lower age (HR=0.98, p=0.01) and female sex (HR=1.68, p=0.02) were associated with a higher relapse risk after discontinuation. Conclusions Based on average ARR levels, there was no evidence of clinical rebound after fingolimod discontinuation. In total, 12.5% of patients had clinical rebound. Only 3.6%, however, had clinical rebound without disease activity before discontinuation. Disease activity before discontinuation, female sex and younger age were statistically significantly associated with a higher relapse risk after discontinuation.
AB - Objective We investigated whether clinical rebound occurred after fingolimod discontinuation in a complete population of patients with relapsing-remitting multiple sclerosis (RRMS) in Denmark. We further identified clinical and demographical factors associated with disease reactivation after fingolimod discontinuation. Methods The population comprised 992 RRMS patients treated with fingolimod for 6 months or more. We estimated annualised relapse rates (ARR) before, during and after treatment. We estimated overall ARRs and ARRs stratified by disease activity before discontinuation. We calculated the proportion of patients with a higher clinical disease activity after discontinuation than before treatment start. Finally, we analysed the association between variables at discontinuation and time to first relapse after discontinuation. Results The ARR 3 months after discontinuation (ARR=0.56; 95% CI=0.47 to 0.66) was statistically significantly lower (p<0.01) than the ARR 1 year before treatment (ARR=0.74; 95% CI=0.69 to 0.80). Results were similar when repeating analyses in patients with and without disease activity before discontinuation. In total, 124 patients (12.5%) had clinical rebound. Of those, 36 had no disease breakthrough before discontinuation (3.6% of total population). On treatment disease activity (HR=1.98, p<0.01), lower age (HR=0.98, p=0.01) and female sex (HR=1.68, p=0.02) were associated with a higher relapse risk after discontinuation. Conclusions Based on average ARR levels, there was no evidence of clinical rebound after fingolimod discontinuation. In total, 12.5% of patients had clinical rebound. Only 3.6%, however, had clinical rebound without disease activity before discontinuation. Disease activity before discontinuation, female sex and younger age were statistically significantly associated with a higher relapse risk after discontinuation.
KW - MULTIPLE SCLEROSIS
KW - NEUROIMMUNOLOGY
U2 - 10.1136/jnnp-2022-329607
DO - 10.1136/jnnp-2022-329607
M3 - Journal article
C2 - 36171103
AN - SCOPUS:85142647994
VL - 93
SP - 1317
EP - 1321
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
SN - 0022-3050
IS - 12
ER -
ID: 340549019