title: Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS.
abstract: OBJECTIVE
  First-line immunomodulatory treatment with interferon-beta or glatiramer acetate is accepted as effective basic therapy in patients with relapsing-remitting multiple sclerosis (RRMS). However, a considerable portion of patients does not benefit from treatment.
  
  
  METHODS
  To test basic immunomodulatory treatment under real-life conditions, we retrospectively analyzed clinical and subclinical disease activity within the last 12 months in a cohort of 9916 patients with RRMS, of which 7896 patients were receiving immunomodulatory treatment. In addition, factors associated with treating physicians' consideration of a switch of current treatment were assessed.
  
  
  RESULTS
  The majority of treated patients (approximately 66%) experienced no relapse during the last 12 months. However, in line with common clinical study findings, about one-third (approximately 34%) of patients had relapses. When MRI data were taken into account, approximately one-quarter (24%) of patients would qualify for therapy escalation to monoclonal antibody natalizumab. Relapse rate in the preceding year (the year directly prior to the start of retrospective data collection) was strongly associated with considering a switch of current treatment. In addition, therapy switch was more often considered in younger patients. The relationship between MRI findings in the absence of clinical symptoms and consideration of a treatment switch was not as clear.
  
  
  CONCLUSIONS
  This analysis confirms that disease progression occurs in a considerable proportion of patients with RRMS. These patients should be considered for therapy escalation.
authors.affiliation: Department of Neurology, Caritas Hospital Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim, Germany. Mathias.Maeurer@ckbm.de
authors.forename: M
authors.initials: M
authors.lastname: Mäurer
authors.forename: R
authors.initials: R
authors.lastname: Dachsel
authors.forename: S
authors.initials: S
authors.lastname: Domke
authors.forename: S
authors.initials: S
authors.lastname: Ries
authors.forename: G
authors.initials: G
authors.lastname: Reifschneider
authors.forename: A
authors.initials: A
authors.lastname: Friedrich
authors.forename: P
authors.initials: P
authors.lastname: Knorn
authors.forename: H
authors.initials: H
authors.lastname: Landefeld
authors.forename: G
authors.initials: G
authors.lastname: Niemczyk
authors.forename: P
authors.initials: P
authors.lastname: Schicklmaier
authors.forename: C
authors.initials: C
authors.lastname: Wernsdörfer
authors.forename: S
authors.initials: S
authors.lastname: Windhagen
authors.forename: H
authors.initials: H
authors.lastname: Albrecht
authors.forename: S
authors.initials: S
authors.lastname: Schwab
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D000068717:Glatiramer Acetate; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D000069442:Natalizumab; D010455:Peptides / Q000627:therapeutic use; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069442:Natalizumab; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta