Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry.

Humans Multiple Sclerosis / drug therapy Immunologic Factors / therapeutic use Multiple Sclerosis, Relapsing-Remitting / drug therapy Cross-Sectional Studies Multiple Sclerosis, Chronic Progressive / drug therapy Recurrence Italy / epidemiology
Disease activity Disease-modifying therapies Multiple sclerosis Treatment switch

Journal

Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161

Informations de publication

Date de publication:
Mar 2024
Historique:
received: 08 08 2023
accepted: 23 11 2023
revised: 22 11 2023
medline: 27 2 2024
pubmed: 23 12 2023
entrez: 22 12 2023
Statut: ppublish

Résumé

Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD). RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs]. A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs. More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.

Sections du résumé

BACKGROUND BACKGROUND
Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD).
METHODS METHODS
RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs].
RESULTS RESULTS
A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs.
CONCLUSIONS CONCLUSIONS
More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.

Identifiants

DOI: 10.1007/s00415-023-12137-8 PMID: 38135850
pubmed: 38135850
doi: 10.1007/s00415-023-12137-8
pii: 10.1007/s00415-023-12137-8
doi:

Substances chimiques

Immunologic Factors 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1150-1159

Subventions

Organisme : Novartis Pharmaceuticals Corporation
ID : This project was supported by Novartis Italy on a basis of a sponsored research agreement between Novartis
Organisme : Novartis Pharmaceuticals Corporation
ID : the University of Bari Aldo Moro.

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Références

Filippi M, Danesi R, Derfuss T et al (2022) Early and unrestricted access to high-efficacy disease-modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis. J Neurol 269(3):1670–1677. https://doi.org/10.1007/s00415-021-10836-8
doi: 10.1007/s00415-021-10836-8 pubmed: 34626224
European Medicines Agency. Guideline on clinical investigation of medicinal products for the treatment of Multiple Sclerosis. EMA/CHMP/771815/2011, https://www.ema.europa.eu/en/documents/scientific-guideline/guidelineclinical-investigation-medicinal-productstreatment-multiple-sclerosis_en-0.pdf
Bayas A, Christ M, Faissner S et al (2023) Disease-modifying therapies for relapsing/active secondary progressive multiple sclerosis—a review of population-specific evidence from randomized clinical trials. Ther Adv Neurol Disord. https://doi.org/10.1177/17562864221146836 . (Published 2023 Jan 24)
doi: 10.1177/17562864221146836 pubmed: 37780055 pmcid: 10540601
Gross RH, Corboy JR (2019) Monitoring, switching, and stopping multiple sclerosis disease-modifying therapies [published correction appears in Continuum (Minneap Minn). 2019 Aug;25(4):1175]. Continuum (Minneap Minn). 25(3):715–735. https://doi.org/10.1212/CON.00000000000007383
doi: 10.1212/CON.00000000000007383 pubmed: 31162313
Ziemssen T, Derfuss T, de Stefano N et al (2016) Optimizing treatment success in multiple sclerosis. J Neurol 263(6):1053–1065. https://doi.org/10.1007/s00415-015-7986-y
doi: 10.1007/s00415-015-7986-y pubmed: 26705122
He A, Merkel B, Brown JWL et al (2020) Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol 19(4):307–316. https://doi.org/10.1016/S1474-4422(20)30067-3
doi: 10.1016/S1474-4422(20)30067-3 pubmed: 32199096
Harding K, Williams O, Willis M et al (2019) Clinical outcomes of escalation vs early intensive disease-modifying therapy in patients with multiple sclerosis. JAMA Neurol 76(5):536–541. https://doi.org/10.1001/jamaneurol.2018.4905
doi: 10.1001/jamaneurol.2018.4905 pubmed: 30776055 pmcid: 6515582
Merkel B, Butzkueven H, Traboulsee AL, Havrdova E, Kalincik T (2017) Timing of high-efficacy therapy in relapsing–remitting multiple sclerosis: A systematic review. Autoimmun Rev 16(6):658–665. https://doi.org/10.1016/j.autrev.2017.04.010
doi: 10.1016/j.autrev.2017.04.010 pubmed: 28428119
Hauser SL, Cree BAC (2020) Treatment of multiple sclerosis: a review. Am J Med 133(12):1380-1390.e2. https://doi.org/10.1016/j.amjmed.2020.05.049
doi: 10.1016/j.amjmed.2020.05.049 pubmed: 32682869 pmcid: 7704606
Iaffaldano P, Lucisano G, Butzkueven H et al (2021) Early treatment delays long-term disability accrual in RRMS: results from the BMSD network. Mult Scler 27(10):1543–1555. https://doi.org/10.1177/13524585211010128
doi: 10.1177/13524585211010128 pubmed: 33900144
Trojano M, Bergamaschi R, Amato MP et al (2019) The Italian multiple sclerosis register [published correction appears in Neurol Sci. 2019 Apr;40(4):907]. Neurol Sci 40(1):155–165. https://doi.org/10.1007/s10072-018-3610-0
doi: 10.1007/s10072-018-3610-0 pubmed: 30426289
Magyari M, Joensen H, Laursen B, Koch-Henriksen N (2021) The Danish Multiple Sclerosis Registry. Brain Behav 11(1):e01921. https://doi.org/10.1002/brb3.1921
doi: 10.1002/brb3.1921 pubmed: 33128351
Trojano M, Kalincik T, Iaffaldano P, Amato MP (2022) Interrogating large multiple sclerosis registries and databases: what information can be gained? Curr Opin Neurol 35(3):271–277. https://doi.org/10.1097/WCO.0000000000001057
doi: 10.1097/WCO.0000000000001057 pubmed: 35674068
Lorscheider J, Buzzard K, Jokubaitis V et al (2016) Defining secondary progressive multiple sclerosis. Brain 139(Pt 9):2395–2405. https://doi.org/10.1093/brain/aww173
doi: 10.1093/brain/aww173 pubmed: 27401521
Iaffaldano P, Lucisano G, Patti F et al (2021) Transition to secondary progression in relapsing-onset multiple sclerosis: definitions and risk factors. Mult Scler 27(3):430–438. https://doi.org/10.1177/1352458520974366
doi: 10.1177/1352458520974366 pubmed: 33210986
https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2023-03-27&atto.codiceRedazionale=23A01958&elenco30giorni=false . Accessed 16 Nov 2023
https://www.iss.it/documents/20126/8331678/LG-340-SIN_SM.pdf/b3801eb6-2662-37b6-faeb-3612dd99364c?t=1677495451891 . Accessed 16 Nov 2023
Scott TF, Diehl D, Elmalik W, Gettings EJ, Hackett C, Schramke CJ (2019) Multiple sclerosis relapses contribute to long-term disability. Acta Neurol Scand 140(5):336–341. https://doi.org/10.1111/ane.13149
doi: 10.1111/ane.13149 pubmed: 31314902
Jokubaitis VG, Spelman T, Kalincik T et al (2016) Predictors of long-term disability accrual in relapse-onset multiple sclerosis. Ann Neurol 80(1):89–100. https://doi.org/10.1002/ana.24682
doi: 10.1002/ana.24682 pubmed: 27145331
Lublin FD, Häring DA, Ganjgahi H et al (2022) How patients with multiple sclerosis acquire disability. Brain 145(9):3147–3161. https://doi.org/10.1093/brain/awac016
doi: 10.1093/brain/awac016 pubmed: 35104840 pmcid: 9536294
Rotstein D, Montalban X (2019) Reaching an evidence-based prognosis for personalized treatment of multiple sclerosis. Nat Rev Neurol 15(5):287–300. https://doi.org/10.1038/s41582-019-0170-8
doi: 10.1038/s41582-019-0170-8 pubmed: 30940920
Montalban X, Gold R, Thompson AJ, Otero-Romero S, Amato MP, Chandraratna D et al (2018) ECTRIMS/EAN guideline on the pharmacological treatment of people with multiple sclerosis. Mult Scler 24(2):96–120
doi: 10.1177/1352458517751049 pubmed: 29353550
Rae-Grant A, Day GS, Marrie RA, Rabinstein A, Cree BAC, Gronseth GS et al (2018) Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology. Neurology 90(17):777–788
doi: 10.1212/WNL.0000000000005347 pubmed: 29686116
Patti F, Chisari CG, D’Amico E et al (2020) Clinical and patient determinants of changing therapy in relapsing–remitting multiple sclerosis (SWITCH study). Mult Scler Relat Disord 42:102124. https://doi.org/10.1016/j.msard.2020.102124
doi: 10.1016/j.msard.2020.102124 pubmed: 32353755
Seifer G, Arun T, Capela C et al (2023) Influence of physicians’ risk perception on switching treatments between high-efficacy and non-high-efficacy disease-modifying therapies in multiple sclerosis. Mult Scler Relat Disord 76:104770. https://doi.org/10.1016/j.msard.2023.104770
doi: 10.1016/j.msard.2023.104770 pubmed: 37307690
Saccà F, Lanzillo R, Signori A et al (2019) Determinants of therapy switch in multiple sclerosis treatment-naïve patients: a real-life study. Mult Scler 25(9):1263–1272. https://doi.org/10.1177/1352458518790390
doi: 10.1177/1352458518790390 pubmed: 30044207
Hillert J, Magyari M, SoelbergSørensen P et al (2021) Treatment switching and discontinuation over 20 years in the big multiple sclerosis data network. Front Neurol 12:647811. https://doi.org/10.3389/fneur.2021.647811 . (Published 2021 Mar 17)
doi: 10.3389/fneur.2021.647811 pubmed: 33815259 pmcid: 8010264
Chisari CG, Sgarlata E, Arena S, Toscano S, Luca M, Patti F (2022) Rituximab for the treatment of multiple sclerosis: a review. J Neurol 269(1):159–183. https://doi.org/10.1007/s00415-020-10362-z
doi: 10.1007/s00415-020-10362-z pubmed: 33416999
Pontieri L, Blinkenberg M, Bramow S et al (2022) Ocrelizumab treatment in multiple sclerosis: a Danish population-based cohort study. Eur J Neurol 29(2):496–504. https://doi.org/10.1111/ene.15142
doi: 10.1111/ene.15142 pubmed: 34644452
Lamb YN (2022) Ocrelizumab: a review in multiple sclerosis. Drugs 82(3):323–334. https://doi.org/10.1007/s40265-022-01672-9
doi: 10.1007/s40265-022-01672-9 pubmed: 35192158 pmcid: 8862399
Zhu C, Kalincik T, Horakova D et al (2023) Comparison between dimethyl fumarate, fingolimod, and ocrelizumab after natalizumab cessation. JAMA Neurol 80(7):739–748. https://doi.org/10.1001/jamaneurol.2023.1542
doi: 10.1001/jamaneurol.2023.1542 pubmed: 37273217
Iaffaldano P, Lucisano G, Caputo F et al (2021) Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies. Ther Adv Neurol Disord 14:17562864211019574. https://doi.org/10.1177/17562864211019574 . (Published 2021 May 31)
doi: 10.1177/17562864211019574 pubmed: 34104220 pmcid: 8170278
Kappos L (2021) No consensus about consensus? Neurol Res Pract. 3(1):46. https://doi.org/10.1186/s42466-021-00144-x . (Published 2021 Aug 6)
doi: 10.1186/s42466-021-00144-x pubmed: 34362472 pmcid: 8344178
Filippi M, Amato MP, Centonze D et al (2022) Early use of high-efficacy disease-modifying therapies makes the difference in people with multiple sclerosis: an expert opinion [published correction appears in J Neurol. 2022 Dec;269(12):6690–6691]. J Neurol 269(10):5382–5394. https://doi.org/10.1007/s00415-022-11193-w
doi: 10.1007/s00415-022-11193-w pubmed: 35608658 pmcid: 9489547
Butzkueven H, Kappos L, Wiendl H et al (2020) Long-term safety and effectiveness of natalizumab treatment in clinical practice: 10 years of real-world data from the Tysabri Observational Program (TOP). J Neurol Neurosurg Psychiatry 91(6):660–668. https://doi.org/10.1136/jnnp-2019-322326
doi: 10.1136/jnnp-2019-322326 pubmed: 32234967
Jakimovski D, Vaughn CB, Eckert S, Zivadinov R, Weinstock-Guttman B (2020) Long-term drug treatment in multiple sclerosis: safety success and concerns. Expert Opin Drug Saf 19(9):1121–1142. https://doi.org/10.1080/14740338.2020.1805430
doi: 10.1080/14740338.2020.1805430 pubmed: 32744073

Auteurs

Pietro Iaffaldano (P)

Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.

Giuseppe Lucisano (G)

Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.

Tommaso Guerra (T)

Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.

Francesco Patti (F)

Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy.
UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy.

Eleonora Cocco (E)

Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy.

Giovanna De Luca (G)

Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy.

Vincenzo Brescia Morra (V)

Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.

Carlo Pozzilli (C)

Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy.

Mauro Zaffaroni (M)

Neuroimmunology Unit and Multiple Sclerosis Center, ASST Della Valle Olona, Hospital of Gallarate, Via Pastori 4, 21013, Gallarate, VA, Italy.

Diana Ferraro (D)

Department of Neurosciences, Ospedale Civile di BaggiovaraAzienda Ospedaliero-Universitaria di Modena, Modena, Italy.

Claudio Gasperini (C)

Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy.

Giuseppe Salemi (G)

Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy.

Roberto Bergamaschi (R)

IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.

Giacomo Lus (G)

Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.

Matilde Inglese (M)

Dipartimento di NeuroscienzeRiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), Universita' di Genova, Genova, Italy.
IRCCS, Ospedale Policlinico San Martino, Genova, Italy.

Silvia Romano (S)

Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Italy.

Paolo Bellantonio (P)

Unit of Neurology, IRCCS Neuromed, Pozzilli, Italy.

Elisabetta Di Monte (E)

Center for Multiple Sclerosis, Hospital ASL 4 "Madonna delle Grazie", 75100, Matera, Italy.

Giorgia Teresa Maniscalco (GT)

Neurology and Stroke Unit, MS Center "A. Cardarelli Hospital", Naples, Italy.

Antonella Conte (A)

Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.
Neurophysiopatology Unit, IRCCS Neuromed, Pozzilli, IS, Italy.

Alessandra Lugaresi (A)

IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.

Marika Vianello (M)

MS Unit, OU Neurology "Ca' Foncello" Hospital, Treviso, Italy.

Valentina Liliana Adriana Torri Clerici (VLA)

Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Alessia Di Sapio (A)

Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy.

Ilaria Pesci (I)

Neurology Unit, Ospedale Vaio-Fidenza, Parma, Italy.

Franco Granella (F)

Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy.

Rocco Totaro (R)

Centro Malattie Demielinizzanti-Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Coppito, Italy.

Girolama Alessandra Marfia (GA)

Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy.

Maura Chiara Danni (MC)

Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.

Paola Cavalla (P)

Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.

Paola Valentino (P)

Istituto di neurologia, Università Magna Graecia Catanzaro, Catanzaro, Italy.

Umberto Aguglia (U)

Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Sara Montepietra (S)

MS Centre, SMN Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy.

Elisabetta Ferraro (E)

Centro SM, PO San Filippo Neri, ASL Roma 1, Rome, Italy.

Alessandra Protti (A)

MS Center, Neuroscience Department, Niguarda Hospital, Milan, Italy.

Daniele Spitaleri (D)

MS Center, Neurology UNIT- Hospital San G. Moscati, Avellino, Italy.

Carlo Avolio (C)

MS Center, University of Neurology, Foggia, Italy.

Milena De Riz (M)

Centro Sclerosi Multipla-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.

Davide Maimone (D)

Centro Sclerosi Multipla, ARNAS Garibaldi, Catania, Italy.

Guido Cavaletti (G)

IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy.

Paola Gazzola (P)

SC Neurologia, Ospedale P. Antero Micone-ASL 3 Genovese, Genoa, Italy.

Gioacchino Tedeschi (G)

I Division of Neurology, Universita della Campania "L. Vanvitelli", Naples, Italy.

Maria Sessa (M)

Centro Provinciale Sclerosi Multipla, ASST papa Giovanni XXIII, Bergamo, Italy.

Marco Rovaris (M)

MS Center, Scientific Institute Fondazione Don Carlo Gnocchi, Milan, Italy.

Franco Di Palma (F)

SM Center Neurology Department, ASST Lariana S. Anna Hospital, Como, Italy.

Maurizia Gatto (M)

Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy.

Daniela Cargnelutti (D)

SOC Neurologia-ASUFC, Udine, Italy.

Francesca De Robertis (F)

MS Ambulatory Neurological Clinical of Lecce, Lecce, Italy.

Francesco Ottavio Logullo (FO)

UOC Neurologia, AST Pesaro, Urbino, Italy.

Augusto Rini (A)

Centro Sclerosi Multipla, Ospedale A. Perrino, Brindisi, Italy.

Giuseppe Meucci (G)

Ambulatorio Sclerosi MultiplaUnita' Operativa di Neurologia e Neurofisiopatologia, Spedali Riuniti di Livorno, Livorno, Italy.

Bonaventura Ardito (B)

Centro Sclerosi Mutipla UOC di Neurologia, Ospedale Della Murgia Fabio Perinei, Altamura, Italy.

Paola Banfi (P)

Dipartimento di Neurologia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.

Davide Nasuelli (D)

ASST Della Valle Olona Presidio Ospedaliero di Saronno Ambulatorio Sclerosi Multipla, Saronno, Italy.

Damiano Paolicelli (D)

Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.

Maria Assunta Rocca (MA)

Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy.

Emilio Portaccio (E)

Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy.

Clara Grazia Chisari (CG)

Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy.
UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy.

Giuseppe Fenu (G)

Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy.

Marco Onofrj (M)

Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy.

Antonio Carotenuto (A)

Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.

Serena Ruggieri (S)

Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy.

Carla Tortorella (C)

Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy.

Paolo Ragonese (P)

Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy.

Mihaela Nica (M)

Novartis Italia, Milan, Italy.

Maria Pia Amato (MP)

Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.

Massimo Filippi (M)

Neurology and Neurorehabilitation Units, Neurophysiology Service, Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy.

Maria Trojano (M)

School of Medicine, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, Bari, Italy. maria.trojano@uniba.it.
ORCID: 0000-0002-6329-8946

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

Recherchemedicale.com › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Sclérose en plaques › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Facteurs immunologiques › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Sclérose en plaques › Sclérose en plaques récurrente-rémittente › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Sclérose en plaques chronique progressive › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Récidive › Evaluation of drivers of treatment switch in...
Recherchemedicale.com › Régions géographiques › Europe › Italie › Evaluation of drivers of treatment switch in...