Disease modifying therapy reduces the risk of disability in relapsing-remitting multiple sclerosis over 15 years

Objective: To test the hypothesis that immunotherapy prevents long-term disability in relapsing-remitting multiple sclerosis, we modelled disability outcomes in 14,717 patients.

Methods: We studied patients from MSBase followed for ≥1 year, with ≥3 visits, ≥1 visit per year and exposed to a multiple sclerosis therapy, and a subset of patients with ≥15-year follow-up. Marginal structural models were used to compare the hazard of 12-month confirmed increase and decrease in disability, EDSS step 6 and the incidence of relapses between treated and untreated periods. Marginal structural models were continuously re-adjusted for patient age, sex, pregnancy, date, disease course, time from first symptom, prior relapse history, disability and MRI activity.

Results: 14,717 patients were studied. During the treated periods, patients were less likely to experience relapses (hazard ratio 0.60, 95% confidence interval 0.43-0.82, p=0.0016), worsening of disability (0.56, 0.38-0.82, p=0.0026) and...

目的：为验证免疫疗法（immunotherapy）可预防复发缓解型多发性硬化症（relapsing-remitting multiple sclerosis）患者长期残疾的假设，我们对14717例患者的残疾结局进行了建模分析。

方法：本研究纳入MSBase数据库中随访≥1年、就诊≥3次、每年≥1次就诊且接受过多发性硬化症治疗的患者，以及随访≥15年的亚组患者。采用边际结构模型（Marginal Structural Models）比较治疗期与未治疗期患者的12个月确认残疾加重及减轻风险、扩展残疾状态量表（EDSS）6分风险，以及复发发生率。边际结构模型持续重新调整患者年龄、性别、妊娠状态、日期、病程、首次症状出现时间、既往复发史、残疾程度及磁共振成像（MRI）活性等变量。

结果：共纳入14717例患者。治疗期间，患者复发风险降低（风险比（hazard ratio）0.60，95%置信区间（95% confidence interval）0.43-0.82，p=0.0016），残疾加重风险降低（0.56，0.38-0.82，p=0.0026），且...