title: Country, sex, EDSS change and therapy choice independently predict treatment discontinuation in multiple sclerosis and clinically isolated syndrome.
abstract: OBJECTIVE
  We conducted a prospective study, MSBASIS, to assess factors leading to first treatment discontinuation in patients with a clinically isolated syndrome (CIS) and early relapsing-remitting multiple sclerosis (RRMS).
  
  
  METHODS
  The MSBASIS Study, conducted by MSBase Study Group members, enrols patients seen from CIS onset, reporting baseline demographics, cerebral magnetic resonance imaging (MRI) features and Expanded Disability Status Scale (EDSS) scores. Follow-up visits report relapses, EDSS scores, and the start and end dates of MS-specific therapies. We performed a multivariable survival analysis to determine factors within this dataset that predict first treatment discontinuation.
  
  
  RESULTS
  A total of 2314 CIS patients from 44 centres were followed for a median of 2.7 years, during which time 1247 commenced immunomodulatory drug (IMD) treatment. Ninety percent initiated IMD after a diagnosis of MS was confirmed, and 10% while still in CIS status. Over 40% of these patients stopped their first IMD during the observation period. Females were more likely to cease medication than males (HR 1.36, p = 0.003). Patients treated in Australia were twice as likely to cease their first IMD than patients treated in Spain (HR 1.98, p = 0.001). Increasing EDSS was associated with higher rate of IMD cessation (HR 1.21 per EDSS unit, p<0.001), and intramuscular interferon-β-1a (HR 1.38, p = 0.028) and subcutaneous interferon-β-1a (HR 1.45, p = 0.012) had higher rates of discontinuation than glatiramer acetate, although this varied widely in different countries. Onset cerebral MRI features, age, time to treatment initiation or relapse on treatment were not associated with IMD cessation.
  
  
  CONCLUSIONS
  In this multivariable survival analysis, female sex, country of residence, EDSS change and IMD choice independently predicted time to first IMD cessation.
authors: Department of Neurology, Royal Melbourne Hospital, Victoria, Australia.
authors: Claire
authors: C
authors: Meyniel
authors: Timothy
authors: T
authors: Spelman
authors: Vilija G
authors: VG
authors: Jokubaitis
authors: Maria
authors: M
authors: Trojano
authors: Guillermo
authors: G
authors: Izquierdo
authors: François
authors: F
authors: Grand'Maison
authors: Celia
authors: C
authors: Oreja-Guevara
authors: Cavit
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authors: Boz
authors: Alessandra
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authors: Lugaresi
authors: Marc
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authors: Girard
authors: Pierre
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authors: Grammond
authors: Gerardo
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authors: Iuliano
authors: Marcela
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authors: Fiol
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authors: JA
authors: Cabrera-Gomez
authors: Ricardo
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authors: Fernandez-Bolanos
authors: Giorgio
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authors: Giuliani
authors: Jeannette
authors: J
authors: Lechner-Scott
authors: Edgardo
authors: E
authors: Cristiano
authors: Joseph
authors: J
authors: Herbert
authors: Tatjana
authors: T
authors: Petkovska-Boskova
authors: Roberto
authors: R
authors: Bergamaschi
authors: Vincent
authors: V
authors: van Pesch
authors: Fraser
authors: F
authors: Moore
authors: Norbert
authors: N
authors: Vella
authors: Mark
authors: M
authors: Slee
authors: Vetere
authors: V
authors: Santiago
authors: Michael
authors: M
authors: Barnett
authors: Eva
authors: E
authors: Havrdova
authors: Carolyn
authors: C
authors: Young
authors: Carmen-Adella
authors: CA
authors: Sirbu
authors: Mary
authors: M
authors: Tanner
authors: Michelle
authors: M
authors: Rutherford
authors: Helmut
authors: H
authors: Butzkueven
mesh_terms: D000328:Adult; D003657:Decision Making; D004185:Disability Evaluation; D005260:Female; D005843:Geography; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D057240:Patient Preference; D011379:Prognosis; D016016:Proportional Hazards Models; D012727:Sex Characteristics; D028761:Withholding Treatment
chemical_list: D007155:Immunologic Factors