Abstrakt
Objective To compare the effectiveness of glatiramer acetate (GA) vs intramuscular interferon beta-1a (IFN-beta-1a), we applied a previously published statistical method aimed at identifying patients' profiles associated with efficacy of treatments. Methods Data from 2 independent multiple sclerosis datasets, a randomized study (the Combination Therapy in Patients With Relapsing-Remitting Multiple Sclerosis [CombiRx] trial, evaluating GA vs IFN-beta-1a) and an observational cohort extracted from MSBase, were used to build and validate a treatment response score, regressing annualized relapse rates (ARRs) on a set of baseline predictors.
Results The overall ARR ratio of GA to IFN-beta-1a in the CombiRx trial was 0.72. The response score (made up of a linear combination of age, sex, relapses in the previous year, disease duration, and Expanded Disability Status Scale score) detected differential response of GA vs IFN-beta-1a: in the trial, patients with the largest benefit from GA vs IFN-beta-1a (lower score quartile) had an ARR ratio of 0.40 (95% confidence interval [CI] 0.25-0.63), those in the 2 middle quartiles of 0.90 (95% CI 0.61-1.34), and those in the upper quartile of 1.14 (95% CI 0.59-2.18) (heterogeneity p = 0.012); this result was validated on MSBase, with the corresponding ARR ratios of 0.58 (95% CI 0.46-0.72), 0.92 (95% CI 0.77-1.09,) and 1.29 (95% CI 0.97-1.71); heterogeneity p < 0.0001).
Conclusions We demonstrate the possibility of a criterion, based on patients' characteristics, to choose whether to treat with GA or IFN-beta-1a. This result, replicated on an independent real-life cohort, may have implications for clinical decisions in everyday clinical practice.