title: The Use of Immunosuppressant Therapy for Multiple Sclerosis in Italy: A Multicenter Retroprospective Study.
abstract: BACKGROUND
  Immunosuppressive agents (ISA) have been used in multiple sclerosis (MS) for decades, frequently as off label licensed therapies. Given the new MS treatment landscape, what place do ISA have in combating MS?
  
  
  METHODS
  We conducted a retrospective multicentre study to investigate the frequency of ISA prescription in 17 Italian MS centres, and to describe the clinical factors related to ISA use.
  
  
  RESULTS
  Out of 6,447 MS patients, 2,034 (31.6%) were treated with ISA, with Azathioprine being the most frequently used ISA overall. MS patients treated with ISA alone were more frequently affected by the progressive course (both primary and secondary) of the disease (RRR 5.82, 95% CI 4.14-8.16, p<0.0001), had higher EDSS (RRR 3.69, 95% CI 2.61-5.21, p<0.0001), higher assignment age (RRR 1.04, 95% CI 1.03-1.06, p<0.0001) than patients treated with only disease modifying drugs (DMDs).
  
  
  CONCLUSIONS
  Progressive course, higher EDSS, higher assignment age were the strongest predictors of ISA prescription and use in our population.
authors.affiliation: MS center, Via S. Sofia, 78 95123, Catania, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: D'Amico
authors.affiliation: MS center, Via S. Sofia, 78 95123, Catania, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Leone
authors.affiliation: Scientific Direction, National Cancer Institute "Giovanni Paolo II", Bari, Italy.
authors.forename: Giusi
authors.initials: G
authors.lastname: Graziano
authors.affiliation: Department NEUROFARBA- University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Amato
authors.affiliation: CRISM, Istituto Neurologico Nazionale 'C. Mondino', Via Mondino 2, 27100, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bergamaschi
authors.affiliation: MS center, University of Turin, Via Cherasco, 15, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cavalla
authors.affiliation: MS center, Hospital S. Carlo, Potenza, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Coniglio
authors.affiliation: MS center, Neurologia A.C.O. San Filippo Neri, Roma, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Di Battista
authors.affiliation: Hospital Maggiore, Crema, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ferrò
authors.affiliation: Dipartimento di Neuroscienze, Via Volturno 39, Parma, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Granella
authors.affiliation: MS center, University of Ferrara, Ferrara. Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Granieri
authors.affiliation: MS center, University of Chieti, Chieti, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugaresi
authors.affiliation: Clinica Neurologica I, Seconda Università di Napoli Ed.10 Policlinico Federico II, Via Sergio Pansini 5, 80131, Napoli, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Lus
authors.affiliation: Policlinico Umberto I, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Millefiorini
authors.affiliation: University La Sapienza, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Pozzilli
authors.affiliation: II University of Naples, Napoli, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Tedeschi
authors.affiliation: MS center, Via S. Sofia, 78 95123, Catania, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Zappia
authors.affiliation: HSR, University San Raffaele, Milano, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
authors.affiliation: University of Bari Aldo Moro, Bari, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Trojano
authors.affiliation: University of Bari Aldo Moro, Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Lepore
authors.affiliation: MS center, Via S. Sofia, 78 95123, Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Patti
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007372:Interferons / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D001379:Azathioprine; D007166:Immunosuppressive Agents; D007372:Interferons