{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T19:31:13Z","timestamp":1778787073570,"version":"3.51.4"},"reference-count":26,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Switching between first-line disease-modifying therapies in patients with clinically stable relapsing\u2013remitting multiple sclerosis (RRMS) due to reasons other than disease activity is frequent, but evidence on the effect of this practice is limited. We investigated the effect of switching patients with stable RRMS on occurrences of disability accumulation, relapses and future treatment discontinuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Danish Multiple Sclerosis Registry, we identified patients with RRMS without disease activity who either (1) stayed on injectable platform therapy (interferon-\u03b2 or glatiramer acetate) or (2) switched to dimethyl fumarate (DMF) or teriflunomide (TFL) and compared treatment outcomes using propensity-score-based methods and marginal structural models (MSM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 3206 patients in the study. We found no change in risk of 6-month confirmed Expanded Disability Status Scale score worsening in patients switching to DMF (HR: 1.15, 95% CI 0.88 to 1.50) or TFL (HR: 1.16, 95% CI 0.92 to 1.46). The risk of suffering any relapse tended to decrease when switching to DMF (HR: 0.73, 95% CI 0.51 to 1.04) and tended to increase when switching to TFL (HR: 1.25, 95% CI 0.96 to 1.63). Absolute risk differences were small. MSM analyses showed similar results but did not find an increased relapse risk in TFL switchers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Switching from injectable platform therapies to oral first-line therapies in patients with clinically stable RRMS does not increase the risk of disability accumulation. While the postswitch risk of relapses trended towards marginally higher on TFL, this trend was eliminated by adjustment for time-variant confounders.<\/jats:p><\/jats:sec>","DOI":"10.1136\/jnnp-2020-324869","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T02:00:22Z","timestamp":1610503222000},"page":"556-562","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Effect of lateral therapy switches to oral moderate-efficacy drugs in multiple sclerosis: a nationwide cohort study"],"prefix":"10.1136","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1260-1156","authenticated-orcid":false,"given":"Mathias Due","family":"Buron","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3778-1376","authenticated-orcid":false,"given":"Tomas","family":"Kalincik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Finn","family":"Sellebjerg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per Soelberg","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda","family":"Magyari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,1,12]]},"reference":[{"key":"2022011608400608000_92.5.556.1","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s00415-018-9126-y","article-title":"Treatment escalation leads to fewer relapses compared with switching to another moderately effective therapy","volume":"266","author":"Chalmer","year":"2019","journal-title":"J Neurol"},{"key":"2022011608400608000_92.5.556.2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12929"},{"key":"2022011608400608000_92.5.556.3","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.msard.2017.07.007","article-title":"Clinical and MRI outcomes after stopping or switching disease-modifying therapy in stable MS patients: a case series report","volume":"17","author":"Berkovich","year":"2017","journal-title":"Mult Scler Relat Disord"},{"key":"2022011608400608000_92.5.556.4","doi-asserted-by":"crossref","unstructured":"Prosperini L , Cortese A , Lucchini M . Exit strategies for \u201cneedle fatigue\u201d in multiple sclerosis: a propensity score-matched comparison study. 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