title: Comparative effectiveness of glatiramer acetate and interferon beta formulations in relapsing-remitting multiple sclerosis.
abstract: BACKGROUND
  The results of head-to-head comparisons of injectable immunomodulators (interferon β, glatiramer acetate) have been inconclusive and a comprehensive analysis of their effectiveness is needed.
  
  
  OBJECTIVE
  We aimed to compare, in a real-world setting, relapse and disability outcomes among patients with multiple sclerosis (MS) treated with injectable immunomodulators.
  
  
  METHODS
  Pairwise analysis of the international MSBase registry data was conducted using propensity-score matching. The four injectable immunomodulators were compared in six head-to-head analyses of relapse and disability outcomes using paired mixed models or frailty proportional hazards models adjusted for magnetic resonance imaging variables. Sensitivity and power analyses were conducted.
  
  
  RESULTS
  Of the 3326 included patients, 345-1199 patients per therapy were matched (median pairwise-censored follow-up was 3.7 years). Propensity matching eliminated >95% of the identified indication bias. Slightly lower relapse incidence was found among patients treated with glatiramer acetate or subcutaneous interferon β-1a relative to intramuscular interferon β-1a and interferon β-1b (p≤0.001). No differences in 12-month confirmed progression of disability were observed.
  
  
  CONCLUSIONS
  Small but statistically significant differences in relapse outcomes exist among the injectable immunomodulators. MSBase is sufficiently powered to identify these differences and reflects practice in tertiary MS centres. While the present study controlled indication, selection and attrition bias, centre-dependent variance in data quality was likely.
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia tomas.kalincik@unimelb.edu.au.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kalincik
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Vilija
authors.initials: V
authors.lastname: Jokubaitis
authors.affiliation: Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Izquierdo
authors.affiliation: Hôpital Notre Dame, Montreal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Duquette
authors.affiliation: Hôpital Notre Dame, Montreal, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Girard
authors.affiliation: Hotel-Dieu de Levis, Quebec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Grammond
authors.affiliation: MS Center, Neuroscience, Imaging and Clinical Sciences, University 'G. d'Annunzio', Chieti, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugaresi
authors.affiliation: University Hospital San Carlos, IdISSC, Madrid, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: Oreja-Guevara
authors.affiliation: National Neurological Institute C. Mondino, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
authors.affiliation: Orbis Medical Center, Sittard, the Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: Hupperts
authors.affiliation: Neuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, Canada.
authors.forename: Francois
authors.initials: F
authors.lastname: Grand'Maison
authors.affiliation: Ospedale di Macerata, Macerata, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pucci
authors.affiliation: Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Van Pesch
authors.affiliation: Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Cavit
authors.initials: C
authors.lastname: Boz
authors.affiliation: Ospedali Riuniti di Salerno, Salerno, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Iuliano
authors.affiliation: Hospital Universitario Virgen de Valme, Seville, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fernandez-Bolanos
authors.affiliation: Assaf Harofeh Medical Center, Beer-Yaakov, Israel.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Flechter
authors.affiliation: AORN San Giuseppe Moscati, Avellino, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Spitaleri
authors.affiliation: Hospital Italiano, Buenos Aires, Argentina.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Cristiano
authors.affiliation: Groen Hart Ziekenhuis, Gouda, the Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Verheul
authors.affiliation: John Hunter Hospital, Newcastle, Australia.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lechner-Scott
authors.affiliation: Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Amato
authors.affiliation: Centro Internacional de Restauracion Neurologica, Havana, Cuba.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Cabrera-Gomez
authors.affiliation: INEBA, Buenos Aires, Argentina.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Saladino
authors.affiliation: Flinders University and Medical Centre, Adelaide, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Slee
authors.affiliation: Jewish General Hospital, Montreal, Canada.
authors.forename: Fraser
authors.initials: F
authors.lastname: Moore
authors.affiliation: Craigavon Area Hospital, Portadown, UK.
authors.forename: Orla
authors.initials: O
authors.lastname: Gray
authors.affiliation: St Vincent's Hospital, Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Paine
authors.affiliation: Brain and Mind Research Institute, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Barnett
authors.affiliation: Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, General University Hospital and Charles University in Prague, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Havrdova
authors.affiliation: Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, General University Hospital and Charles University in Prague, Czech Republic.
authors.forename: Dana
authors.initials: D
authors.lastname: Horakova
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy/These authors contributed equally to the manuscript.
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia, and Department of Neurology, Box Hill Hospital, Monash University, Box Hill, Australia.
authors.forename: Helmut
authors.initials: H
authors.lastname: Butzkueven
mesh_terms: D000068717:Glatiramer Acetate / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D012042:Registries; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D000068717:Glatiramer Acetate; D016899:Interferon-beta
keywords: Multiple sclerosis; disability; patient registry; propensity score; real-world date; relapses; treatment outcomes