Incidence and factors associated with treatment failure in the CLIMB multiple sclerosis cohort study.
OBJECTIVE
To determine the rate of treatment failure in patients outside of a controlled treatment trial and to ascertain the factors physicians used to make this decision.


METHODS
One hundred and thirty four patients with the diagnosis of relapsing-remitting (RR) multiple sclerosis (MS) or clinically isolated symptom (CIS) enrolled in the CLIMB study (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital) were treated with either interferon beta or glatiramer acetate as their initial treatment for MS.


RESULTS
The probability of failing initial treatment within 3 years was 30%. Clinical activity, defined as relapses and/or progression in disability, determined treatment failure in 35.7% (n=10) of nonresponders. New T2 hyperintense or gadolinium-enhancing lesions on MRI was used to define treatment failure in 28.6% (n=8) and new MRI lesions were used in combination with clinical activity in 35.7% (n=10). Treatment failures had a higher T2 hyperintense lesion volume (p=0.015) and number of gadolinium-enhancing lesions (p=0.0001) on the enrollment MRI than responders.


CONCLUSIONS
These observations demonstrate that treating physicians use both clinical and MRI parameters to define a response to treatment and initiation of a treatment change and that baseline MRI identified those with increased risk of treatment failure.
Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medical College, United States. sag2015@med.cornell.edu
S A
SA
Gauthier
B I
BI
Glanz
M
M
Mandel
Antonios
A
Tsagkaropoulos
Mohit
M
Neema
James
J
Stankiewicz
Ashish
A
Arora
Yang
Y
Duan
Zsuzsanna
Z
Liptak
Svetlana
S
Egorova
Guy J
GJ
Buckle
Rohit
R
Bakshi
C R G
CR
Guttmann
S J
SJ
Khoury
H L
HL
Weiner
D000328:Adult; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D015994:Incidence; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000473:pathology; D010455:Peptides / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
D003287:Contrast Media; D007155:Immunologic Factors; D010455:Peptides; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D005682:Gadolinium; D000068556:Interferon beta-1a