title: Characteristics influencing therapy switch behavior after suboptimal response to first-line treatment in patients with multiple sclerosis.
abstract: Factors driving disease-modifying therapy (DMT) switch behavior are not well understood.
  
  
  
  The objective of this paper is to identify patient characteristics and clinical events predictive of therapy switching in patients with suboptimal response to DMT.
  
  
  
  This retrospective study analyzed patients with relapsing-remitting multiple sclerosis (MS) and a suboptimal response to initial therapy with either interferon β or glatiramer acetate. Suboptimal responders were defined as patients with ≥1 MS event (clinical relapse, worsening disability, or MRI worsening) while on DMT. Switchers were defined as those who changed DMT within six to 12 months after the MS event.
  
  
  
  Of 606 suboptimal responders, 214 (35.3%) switched therapy. Switchers were younger at symptom onset (p = 0.012), MS diagnosis (p = 0.004), DMT initiation (p < 0.001), and first MS event (p = 0.011) compared with nonswitchers. Compared with one relapse alone, MRI worsening alone most strongly predicted switch behavior (odds ratio 6.3; 95% CI, 3.1-12.9; p < 0.001), followed by ≥2 relapses (2.8; 95% CI, 1.1-7.3; p = 0.040), EDSS plus MRI worsening (2.5; 95% CI, 1.1-5.9; p = 0.031) and EDSS worsening alone (2.2; 95% CI, 1.2-4.1; p = 0.009).
  
  
  
  Younger patients with disease activity, especially MRI changes, are more likely to have their therapy switched sooner than patients who are older at the time of MS diagnosis and DMT initiation.
authors.affiliation: Department of Neurology, Jacobs Neurological Institute, State University of New York at Buffalo, USA New York State Multiple Sclerosis Consortium, USA bteter@buffalo.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Teter
authors.affiliation: Novartis Pharmaceuticals Corporation, USA.
authors.forename: Neetu
authors.initials: N
authors.lastname: Agashivala
authors.affiliation: Department of Neurology, Jacobs Neurological Institute, State University of New York at Buffalo, USA New York State Multiple Sclerosis Consortium, USA.
authors.forename: Katelyn
authors.initials: K
authors.lastname: Kavak
authors.affiliation: Department of Neurology, Jacobs Neurological Institute, State University of New York at Buffalo, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Chouhfeh
authors.affiliation: Novartis Pharmaceuticals Corporation, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Hashmonay
authors.affiliation: Department of Neurology, Jacobs Neurological Institute, State University of New York at Buffalo, USA New York State Multiple Sclerosis Consortium, USA.
authors.forename: Bianca
authors.initials: B
authors.lastname: Weinstock-Guttman
mesh_terms: D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D057915:Drug Substitution; D005260:Female; D000068717:Glatiramer Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016899:Interferon-beta / Q000009:adverse effects / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology; D009518:New York; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000068717:Glatiramer Acetate; D016899:Interferon-beta
keywords: Disease-modifying therapy; MRI; disability; multiple sclerosis; relapse; therapy switch