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Article Dans Une Revue European Journal of Neurology Année : 2021

Untreated patients with multiple sclerosis: A study of French expert centers

1 CHU Clermont-Ferrand
2 APEMAC - Adaptation, mesure et évaluation en santé. Approches interdisciplinaires
3 Service de neurologie [CHRU Nancy]
4 CIC - Centre d'Investigation Clinique [Rennes]
5 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
6 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
7 UB - Université de Bordeaux
8 U1215 Inserm - UB - Neurocentre Magendie : Physiopathologie de la Plasticité Neuronale
9 CHU Bordeaux
10 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
11 CHU Pitié-Salpêtrière [AP-HP]
12 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
13 CHU - Hôpital Lapeyronie [Montpellier]
14 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
15 CHU Caen
16 CHU - Hôpital Pasteur [Nice]
17 CEP - Centre d'épidémiologie des populations
18 CHU Nantes - Centre Hospitalier Universitaire de Nantes
19 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
20 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
21 TIMONE - Hôpital de la Timone [CHU - APHM]
22 CHU Saint-Antoine [AP-HP]
23 Fondation Ophtalmologique Adolphe de Rotschild
24 IGF - Institut de Génomique Fonctionnelle
25 CHI Poissy-Saint-Germain
26 CHU Amiens-Picardie
27 CHU Rouen
28 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
29 CHU de la Martinique [Fort de France]
30 CHU Limoges
31 CHU Henri Mondor [Créteil]
32 CHU ST-E - Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
33 Hôpital universitaire Robert Debré [Reims]
34 CHU Trousseau [Tours]
35 Centre Hospitalier de Saint-Denis [Ile-de-France]
36 Centre Hospitalier René Dubos [Pontoise]
37 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
38 Hôpital Bicêtre
39 Centre Hospitalier Versailles, 78000 Le Chesnay, France
40 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
41 UCBL - Université Claude Bernard Lyon 1
Xavier Moisset
Caroline Papeix
Gilles Defer
  • Fonction : Auteur
Christine Lebrun-Frenay
Thibault Moreau
  • Fonction : Auteur
  • PersonId : 993356
Jean Pelletier
Bruno Stankoff
Eric Thouvenot
  • Fonction : Auteur
  • PersonId : 1037455
Bertrand Bourre
  • Fonction : Auteur
Alexis Montcuquet
  • Fonction : Auteur

Résumé

Background and purpose: Disease-modifying therapies (DMTs) have an impact on relapses and disease progression. Nonetheless, many patients with multiple sclerosis (MS) remain untreated. The objectives of the present study were to determine the proportion of untreated patients with MS followed in expert centers in France and to determine the predictive factors of nontreatment. Methods: We conducted a retrospective cohort study. Data were extracted from the 38 centers participating in the European Database for Multiple Sclerosis (EDMUS) on December 15, 2018, and patients with MS seen at least once during the study period (from June 15, 2016 to June 14, 2017) were included. Results: Of the 21,189 patients with MS (age 47.1 +/- 13.1 years; Expanded Disability Status Scale (EDSS) score 3.4 +/- 2.4), 6,631 (31.3%; 95% confidence interval [CI] 30.7-31.9) were not receiving any DMT. Although patients with a relapsing-remitting course (n = 11,693) were the most likely to receive DMT, 14.8% (95% CI 14.2-15.4) were still untreated (6.8% never treated). After multivariate analysis among patients with relapsing-remitting MS, the main factors explaining never having been treated were: not having >= 9 lesions on brain magnetic resonance imaging (odds ratio [OR] 0.52 [95% CI 0.44-0.61]) and lower EDSS score (OR 0.78 [95% CI 0.74-0.82]). Most patients with progressive MS (50.4% for secondary and 64.2% for primary progressive MS) did not receive any DMT during the study period, while 11.6% of patients with secondary and 34.0% of patients with primary progressive MS had never received any DMT. Conclusion: A significant proportion of patients with MS did not receive any DMT, even though such treatments are reimbursed by the healthcare system for French patients. This result highlights the unmet need for current DMTs for a large subgroup of patients with MS.
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Dates et versions

hal-03188971 , version 1 (21-04-2021)

Identifiants

Citer

Xavier Moisset, Audrey-Anne Fouchard, Bruno Pereira, Frederic Taithe, Guillaume Mathey, et al.. Untreated patients with multiple sclerosis: A study of French expert centers. European Journal of Neurology, 2021, 28 (6), pp.2026-2036. ⟨10.1111/ene.14790⟩. ⟨hal-03188971⟩
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