Medizinische Universität Graz - Research portal
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SHR Neuro Cancer Cardio Lipid Metab Microb
Guger, M; Enzinger, C; Heschl, B; Di, Pauli, F; Gradl, C; Kalcher, S; Kvas, E; Berger, T, , Austrian, MS, Treatment, Registry, (AMSTR).
De-Escalation Treatment Strategies From Natalizumab in Patients With Relapsing Multiple Sclerosis in Austria.
Eur J Neurol. 2025; 32(7):e70282
Doi: 10.1111/ene.70282
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- Co-authors Med Uni Graz
- Enzinger Christian
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- Abstract:
- OBJECTIVES: This study aims to assess the efficacy of de-escalating from natalizumab (NTZ) to cladribine (CLAD), dimethyl fumarate (DMF), fingolimod (FTY), ponesimod (PONE), siponimod (SIPO) and teriflunomide (TERI). MATERIAL AND METHODS: We analyzed data from 388 patients in the Austrian MS Treatment Registry who initiated NTZ treatment and remained on therapy for at least 3 months before switching to one of the moderately effective therapies within 1 year. Patients were required to remain on the de-escalation therapy for at least 3 months. RESULTS: Over a mean treatment duration of 42 months, the estimated ARR (annualized relapse rate) was 0.22 for highly effective therapy and 0.36 for de-escalation therapies over 61 months (p = 0.009). EDSS scores increased significantly from 2.8 to 3.1 during de-escalation (p < 0.001). Relapse probability during the treatment gap varied by interval: 14 patients (5.2%) in the < 3 months group, 14 patients (15.7%) in the 3-6 months group, and 13 patients (39.4%) in the 6-12 months group (p < 0.001). Male sex, lower baseline ARR (prior to the initiation of hDMT) and during transition, older age, shorter disease duration, and lower EDSS scores at both baseline and post-transition were significantly associated with a reduced risk of relapse and longer time to first relapse following de-escalation. CONCLUSIONS: Our findings reveal an increased risk of relapses and EDSS worsening following de-escalation from NTZ. Additionally, relapse probability and EDSS progression were influenced by ARR during transition and EDSS scores at the end of the transition period.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Male - administration & dosage
- Natalizumab - therapeutic use, administration & dosage
- Multiple Sclerosis, Relapsing-Remitting - drug therapy
- Female - administration & dosage
- Austria - administration & dosage
- Adult - administration & dosage
- Middle Aged - administration & dosage
- Registries - administration & dosage
- Immunologic Factors - therapeutic use
- Immunosuppressive Agents - therapeutic use
- Treatment Outcome - administration & dosage
- Nitriles - administration & dosage
- Recurrence - administration & dosage
- Toluidines - therapeutic use