Effectiveness of teriflunomide in patients with relapsing multiple sclerosis who switched from other disease-modifying therapies
Bibliographic record
Abstract
To examine effectiveness of teriflunomide in patients with multiple sclerosis (MS) who switched to teriflunomide from other disease-modifying therapies (DMTs). Retrospective, observational, pre-post analysis of adults with relapsing MS (RMS; relapsing-remitting MS or active secondary progressive MS [aSPMS]) with prescription for teriflunomide between September 1, 2012, and March 31, 2019, and had been treated with another disease-modifying therapy ("switched"). Data were extracted from medical-chart data from a single US neurology center in California. Index was the date of teriflunomide initiation. Data were extracted at 1-year pre-index, index, and 1- and 2-years post-index. Patients were observed until death, loss to follow-up, or study end. A subgroup of patients with aSPMS were also examined. For inferential comparisons, significance was assessed using paired T-test or Wilcoxon rank sum test, as appropriate. P < .05 was considered significant. Eighty patients with RMS formed the main analysis. At index, mean (±SD) age was 44.0 ± 14.6 years, 71.3% were female, mean duration of MS was 9.3 ± 6.4 years. Mean duration of teriflunomide use was 24.9 ± 14.2 months. Magnetic resonance imaging of lesions were "stable" or "improved" in most patients at baseline (92.5%), at 1-year (95.1%) or 2-years (97.6%). Mean annualized relapse rate decreased by 80.8%, from 0.26 at 1-year pre-teriflunomide initiation to 0.05 at 2-years post-index (P < .001). Mean Expanded Disability Status Scale (EDSS) score slightly increased from 1-year pre-index to 1-year post-index (3.84 vs 3.90, respectively; difference: -0.06 [P = .033]) but was nonsignificant from index to 2-years post-index (3.84 vs 3.94; difference: -0.06 [P = .058]). Montreal Cognitive Assessment and timed 25-foot walk test scores remained stable through follow-up. A decrease in proportion of patients with lymphopenia was recorded from index (30.0%) to 2-years post-index (1.3%). In the subset of patients with aSPMS (n = 32), mean annualized relapse rate reduced from 1-year pre-index to 2-years post-index (0.4 vs 0.03; change: -0.38 [P < .001]). EDSS, Montreal Cognitive Assessment, and timed 25-foot walk test scores remained stable in patients with aSPMS. After switching to teriflunomide, patients with RMS (relapsing-remitting MS or aSPMS) experienced a reduction in relapses and evidence for recovery from lymphopenia. Other markers of disability worsening, including EDSS, remained stable after switching to teriflunomide.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".