switching multiple sclerosis patients with breakthrough disease to second-line therapy多发性硬化患者突破疾病转向二线治疗.pdf

Switching Multiple Sclerosis Patients with Breakthrough Disease to Second-Line Therapy 1,2 1 3 1 Tamara Castillo-Trivino , Ellen M. Mowry , Alberto Gajofatto , Dorothee Chabas , Elizabeth Crabtree- 1 1 1 1 1 1 Hartman , Bruce A. Cree , Douglas S. Goodin , Ari J. Green , Darin T. Okuda , Daniel Pelletier , Scott S. 1 4 1 Zamvil , Eric Vittinghoff , Emmanuelle Waubant * 1 Multiple Sclerosis Center, Department of Neurology, University of California San Francisco, San Francisco, California, United States of America, 2 Multiple Sclerosis Unit, ´ Department of Neurology, Hospital Donostia, San Sebastian, Spain, 3 Department of Neurological and Vision Sciences, University of Verona, Verona, Italy, 4 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America Abstract Background: Multiple sclerosis (MS) patients with breakthrough disease on immunomodulatory drugs are frequently offered to switch to natalizumab or immunosuppressants. The effect of natalizumab monotherapy in patients with breakthrough disease is unknown. Methods: This is an open-label retrospective cohort study of 993 patients seen at least four times at the University of California San Francisco MS Center, 95 had breakthrough disease on first-line therapy (60 patients switched to natalizumab, 22 to immunosuppressants and 13 declined the switch [non-switchers]). We used Poisson regression adjust