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  • Improving the decision to s...
    Sabathé, Camille; Casey, Romain; Vukusic, Sandra; Leray, Emmanuelle; Mathey, Guillaume; De Sèze, Jérôme; Ciron, Jonathan; Wiertlewski, Sandrine; Ruet, Aurélie; Pelletier, Jean; Zéphir, Hélène; Michel, Laure; Lebrun-Frenay, Christine; Moisset, Xavier; Thouvenot, Eric; Camdessanché, Jean-Philippe; Bakchine, Serge; Stankoff, Bruno; Al Khedr, Abdullatif; Cabre, Philippe; Maillart, Elisabeth; Berger, Eric; Heinzlef, Olivier; Hankiewicz, Karolina; Moreau, Thibault; Gout, Olivier; Bourre, Bertrand; Wahab, Abir; Labauge, Pierre; Montcuquet, Alexis; Defer, Gilles; Maurousset, Aude; Maubeuge, Nicolas; Dimitri Boulos, Dalia; Ben Nasr, Haïfa; Nifle, Chantal; Casez, Olivier; Laplaud, David-Axel; Foucher, Yohann

    Multiple sclerosis, 02/2023, Letnik: 29, Številka: 2
    Journal Article

    Background: In relapsing-remitting multiple sclerosis (RRMS), early identification of suboptimal responders can prevent disability progression. Objective: We aimed to develop and validate a dynamic score to guide the early decision to switch from first- to second-line therapy. Methods: Using time-dependent propensity scores (PS) from a French cohort of 12,823 patients with RRMS, we constructed one training and two validation PS-matched cohorts to compare the switched patients to second-line treatment and the maintained patients. We used a frailty Cox model for predicting individual hazard ratios (iHRs). Results: From the validation PS-matched cohort of 348 independent patients with iHR ⩽ 0.69, we reported the 5-year relapse-free survival at 0.14 (95% confidence interval (CI) 0.09–0.22) for the waiting group and 0.40 (95% CI 0.32–0.51) for the switched group. From the validation PS-matched cohort of 518 independent patients with iHR > 0.69, these values were 0.37 (95% CI 0.30–0.46) and 0.44 (95% CI 0.37–0.52), respectively. Conclusions: By using the proposed dynamic score, we estimated that at least one-third of patients could benefit from an earlier switch to prevent relapse.