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Cited by 44Multiple Sclerosis Research StudiesHealth Systems, Economic Evaluations, Quality of LifePsoriasis: Treatment and Pathogenesis

Assessing the long-term effectiveness of interferon-beta and glatiramer acetate in multiple sclerosis: final 10-year results from the UK multiple sclerosis risk-sharing scheme

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Palace, Jacqueline, Duddy, Martin, Lawton, Michael, Bregenzer, Thomas, Zhu, Feng, Boggild, Mike, Piske, Benjamin, Robertson, Neil P +6 more·2019·Journal of Neurology, Neurosurgery & Psychiatry
DOI 10.1136/jnnp-2018-318360PMC PMC6518464
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Abstract

Background: Because multiple sclerosis (MS) is a chronic disease causing disability over decades, it is crucial to know if the short-term effects of disease-modifying therapies reported in randomised controlled trials reduce long-term disability. This 10-year prospective observational study of disability outcomes (Expanded Disability Status Scale (EDSS) and utility) was set up, in conjunction with a risk-sharing agreement between payers and producers, to investigate this issue. Methods: The outcomes of the UK treated patients were compared with a modelled untreated control based on the British Columbia MS data set to assess the long-term effectiveness of these treatments. Two complementary analysis models were used: a multilevel model (MLM) and a continuous Markov model. Results: 4862 patients with MS were eligible for the primary analysis (mean and median follow-up times 8.7 and 10 years). EDSS worsening was reduced by 28% (MLM), 7% (Markov) and 24% time-adjusted Markov in the total cohort, and by 31% (MLM) and 14% (Markov) for relapsing remitting patients. The utility worsening was reduced by 23%–24% in the total cohort and by 24%–31% in the RR patients depending on the model used. All sensitivity analyses showed a treatment effect. There was a 4-year (CI 2.7 to 5.3) delay to EDSS 6.0. An apparent waning of treatment effect with time was seen. Subgroup analyses suggested better treatment effects in those treated earlier and with lower EDSS scores. Conclusions: This study supports a beneficial effect on long-term disability with first-line MS disease-modifying treatments, which is clinically meaningful. However the waning effect noted requires further study.

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  • The magnitude of the effect on time to needing a walking aid matches that of treatment with a disease modifying agent such as beta-interferon.

    “Although not comparable in terms of likely mechanism, the magnitude of this effect matches that of treatment with a disease modifying agent such as beta-interferon35.”

    From Locus for severity implicates CNS resilience in progression of multiple sclerosis (2023) · cites this paper as [35]

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Authors
Palace, J., Duddy, M., Lawton, M., Bregenzer, T., Zhu, F., Boggild, M., Piske, B., Robertson, N. P., Oger, J., Tremlett, H., Tilling, K., Ben-Shlomo, Y., Lilford, R., & Dobson, C.
Affiliations
  • University of Oxford (GB)
  • Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
  • University of Bristol (GB)
  • University of British Columbia (CA)
  • Townsville Hospital (AU)
  • University Hospital of Wales (GB)
  • University of Warwick (GB)
Corresponding author
Palace, Jacqueline
ORCID
Venue
Journal of Neurology, Neurosurgery & Psychiatry
Publisher
BMJ
Published
2018-09-21
Volume
90
Issue
3
Pages
251-260
ISSN
  • 0022-3050 (ISSN-L)
  • 1468-330X
DOI
10.1136/jnnp-2018-318360
PMC
PMC6518464
OpenAlex
W2890210692
Cited by
44
References
3
Citations by year
2026: 4 · 2025: 2 · 2024: 1 · 2023: 6 · 2022: 5 · 2021: 12 · 2020: 7 · 2019: 6 · 2018: 1
FWCI
4.94
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Journal of Neurology Neurosurgery & Psychiatry (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion, cc-by-nc)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
  • Explore Bristol Research (submittedVersion, cc-by-nc)
Funders
  • NIHR Health Technology Assessment programme (HTA project 10/55/01 for MLM analysis)
  • Four pharmaeutical companies and department of health (NIHR Health Technology Assessment programme (HTA pshaire cost of administering the scheme)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
Keywords
multiple sclerosis, interferon-beta, glatiramer acetate, disease-modifying therapy, long-term disability, Expanded Disability Status Scale, health-related quality of life, risk-sharing agreements, relapsing-remitting multiple sclerosis, treatment timing, disability progression
MeSH terms
Glatiramer Acetate, Adult, Drug Administration Schedule, Female, United Kingdom, Humans, Immunosuppressive Agents, Male, Markov Chains, Middle Aged, Multiple Sclerosis, Time Factors, Cohort Studies, Treatment Outcome, Interferon-beta

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