Change in the clinical activity of multiple sclerosis after treatment switch for suboptimal response

Eur J Neurol. 2012 Jun;19(6):899-904. doi: 10.1111/j.1468-1331.2011.03648.x. Epub 2012 Jan 31.


Background: Therapy for multiple sclerosis (MS) has a partial efficacy, and a significant proportion of treated patients will develop a suboptimal response with first-line disease-modifying drugs (DMD). Therapy switch in patients with MS can be a strategy after a treatment failure. We studied the change in clinical activity after switching of first-line DMD because of a treatment failure.

Methods: Relapsing-remitting multiple sclerosis (RRMS) patients treated with interferon-beta (IFNB) or glatiramer acetate (GA) were divided into (i) patients without change in DMD, (ii) patients with a change in DMD because of a poor response, and (iii) those with a change in DMD without relation with response. Annualized relapse rate (ARR) and relapse-free proportions were analyzed.

Results: We identified 923 patients with RRMS. Of the 180 who experienced a change because of suboptimal response, 90 switched to another first-line DMT, 38 to mitoxantrone, and 52 to natalizumab. Median ARR in the pre-DMD period on first DMD and second DMD was the following: 1, 1, and 0 for switchers from IFNB to another IFNB (P = 0.0001); 0.67, 1, and 0 for switchers from GA to IFNB (P = 0.01); 1, 1, and 0 for switchers from an IFNB to GA (P = 0.02); 1.1, 1.5, 0.2 for switchers from IFNB or GA to mitoxantrone (P = 0.0001); 0.9, 1, 0 for switchers from IFNB or GA to natalizumab (P = 0.0001).

Conclusions: In patients with RRMS who have a poor response, switch to another DMD may reduce the clinical activity of the disease.

MeSH terms

  • Adult
  • Female
  • Glatiramer Acetate
  • Humans
  • Immunologic Factors / therapeutic use*
  • Interferon-beta / therapeutic use*
  • Male
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / physiopathology*
  • Peptides / therapeutic use*
  • Secondary Prevention
  • Treatment Failure
  • Young Adult


  • Immunologic Factors
  • Peptides
  • Glatiramer Acetate
  • Interferon-beta