期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 308, 期 3, 页码 247-256出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2012.7625
关键词
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资金
- endMS Research and Training Network
- European Committee for Treatment and Research in Multiple Sclerosis
- International Society for Pharmacoepidemiology
- Bayer Schering Pharma
- Aventis
- Bayer
- Biogen-Idec
- BioMS
- Corixa
- Genentech
- Novartis
- Serono
- Shering
- Talecris
- Teva-Neurosciences
- Biogen Idec
- Bayer Pharma
- Bayer Canada
- Bayhill Therapeutics
- BTG International
- Merck-Serono
- Consortium of MS Centres
- US National MS Society
- Swiss Multiple Sclerosis Society
- University of British Columbia Multiple Sclerosis Research Program
- Bayer Pharmaceuticals
- Teva Pharmaceuticals
- Canadian Institutes of Health Research (CIHR) [MOP-93646]
- National Multiple Sclerosis Society (NMSS) [RG 4202-A-2]
- Multiple Sclerosis Society of Canada
- CIHR [MOP-93646]
- NMSS [RG 4202-A-2]
- Michael Smith Foundation for Health Research
- Christopher Foundation
- University of British Columbia (UBC)
- Medical Services Commission of British Columbia
- Natural Sciences and Engineering Research Council of Canada
- Multiple Sclerosis Society of Canada (Don Paty Career Development Award)
- UK Multiple Sclerosis Trust
- NMSS
- Donald Paty
context Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established. Objective To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS. Design, Setting, and Patients Retrospective cohort study based on prospectively collected data (1985-2008) from British Columbia, Canada. Patients with relapsing-remitting MS treated with interferon beta (n=868) were compared with untreated contemporary (n=829) and historical (n=959) cohorts. Main Outcome Measures The main outcome measure was time from interferon beta treatment eligibility (baseline) to a confirmed and sustained score of 6 (requiring a cane to walk 100 m; confirmed at >150 days with no measurable improvement) on the Expanded Disability Status Scale (EDSS) (range, 0-10, with higher scores indicating higher disability). A multivariable Cox regression model with interferon beta treatment included as a time-varying covariate was used to assess the hazard of disease progression associated with interferon beta treatment. Analyses also included propensity score adjustment to address confounding by indication. Results The median active follow-up times (first to last EDSS measurement) were as follows: for the interferon beta-treated cohort, 5.1 years (interquartile range [IQR], 3.0-7.0 years); for the contemporary control cohort, 4.0 years (IQR, 2.1-6.4 years); and for the historical control cohort, 10.8 years (IQR, 6.3-14.7 years). The observed outcome rates for reaching a sustained EDSS score of 6 were 10.8%, 5.3%, and 23.1% in the 3 cohorts, respectively. After adjustment for potential baseline confounders (sex, age, disease duration, and EDSS score), exposure to interferon beta was not associated with a statistically significant difference in the hazard of reaching an EDSS score of 6 when either the contemporary control cohort (hazard ratio, 1.30; 95% CI, 0.92-1.83; P=.14) or the historical control cohort (hazard ratio, 0.77; 95% CI, 0.58-1.02; P=.07) were considered. Further adjustment for comorbidities and socioeconomic status, where possible, did not change interpretations, and propensity score adjustment did not substantially change the results. Conclusion Among patients with relapsing-remitting MS, administration of interferon beta was not associated with a reduction in progression of disability. JAMA. 2012;308(3):247-256 www.jama.com
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