SWITCHING THERAPIES ANALYSIS IN MULTIPLE SCLEROSIS PATIENTS

Introduction: disease-modifying treatments (DMTs) for relapsing multiple sclerosis (MS) have been available starting from the 1990s. Since then, the therapeutic landscape has progressively expanded, so the choice of MS treatment to date is challenging and switching of immunotherapies is often required. The aims of this study were i) to describe and analyse in a real-world setting the reasons of DMTs switches in the court of patients belonging to the MS Centre at the IRCCS Mondino; and ii) to provide real-life insights into currently applied therapeutic strategies. Patients and methods: non-interventional, retro-prospective study, which included MS patients actively referred to the MS Center at IRCCS Mondino, who switched DMT in the years 1994–2020. The key outcome variable was the main reason to switch DMT, as documented in medical charts based on failure of therapy, safety, patient’s wish/tolerability, adverse events (AEs), pregnancy planning, and other. Results: of the total of 355 enrolled MS patients, 68.75% (242) were female and mean age of MS onset was 30.29 years old (± 9.26). A total of 682 switches occurred in this population. The main reason to DMT switch was treatment failure, defined as the presence of clinical or radiological MS activity (43.32%) followed by patient’s wish/tolerability (25.36%), safety (13%), other (9%), adverse events (6%) and pregnancy planning (4%). Reasons for DMT switching differed by year of switch (p < 0.002). Discussion: the method I followed, which is unique in the recent literature, has to be considered an alternative and complementary approach to standard real-world evidence analysis, typically focusing on single treatment (or treatments) rather than the patient and the very event. This study improved current awareness on these dynamics, better characterizing everyday practice switch trends with the ultimate goal of improving disease management and patient care.