{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:05:39Z","timestamp":1789549539264,"version":"build-2803163510"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ther Adv Neurol Disord"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Switching disease-modifying therapies (DMTs) is common in relapsing-remitting multiple sclerosis (RRMS). Vertical switching to higher-efficacy agents generally outperforms horizontal switching within the same efficacy tier, yet horizontal switches remain frequent where escalation is impractical.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To compare real-world outcomes after horizontal versus vertical DMT switches and to identify predictors of successful horizontal switching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective, registry-based observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Adults with RRMS who switched DMTs in the MSBase Registry (2010\u20132023) were analyzed. Horizontal switches were defined as transitions within efficacy tiers, and vertical switches as transitions to a higher tier. Propensity score matching (1:1) generated balanced cohorts. Multivariable mixed-effects models with a random intercept for patients were used to evaluate associations with outcomes. The primary outcome was no evidence of disease activity (NEDA-3) during the treatment period; secondary outcomes included annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) change, confirmed disability worsening (CDW), confirmed disability improvement (CDI), and progression independent of relapse activity (PIRA). Predictors of successful horizontal switching were explored using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 4934 matched switches (2467 pairs) were analyzed. Vertical switching achieved higher NEDA-3 rates than horizontal switching (45.8% vs 33.7%) and was associated with lower ARR, reduced CDW risk, and more frequent CDI; differences in EDSS progression and PIRA were not significant. Among horizontal switchers, 33.7% achieved NEDA-3. Success was associated with lower baseline EDSS, fewer prior relapses, and later-line switching. Outcomes varied by destination therapy: anti-CD20 agents had the highest success (\u224850%), followed by cladribine (\u224843%) and natalizumab (\u224841%), whereas interferon and glatiramer acetate performed the poorest. Switches toward anti-CD20 therapies generally yielded better outcomes than other within-tier changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Vertical switching should be preferred when treatment modification is required, particularly for patients with active disease. However, a subset of patients can achieve disease stability after horizontal switching, especially those with lower disability and fewer prior relapses. The dynamics of horizontal switching may further influence outcomes, warranting prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864251399595","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T06:59:49Z","timestamp":1766559589000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Real-world effectiveness of horizontal switching between disease-modifying therapies in multiple sclerosis: a retrospective analysis of the MSBase Registry"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0206-322X","authenticated-orcid":false,"given":"Enrique","family":"Gomez-Figueroa","sequence":"first","affiliation":[{"name":"Department of Neurology, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde,\u201d Coronel Calder\u00f3n 777, Col. El Retiro, ZC 44280 Guadalajara, Jalisco, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Orozco-Puga","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia Patricia","family":"Corona-V\u00e1zquez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2309-4229","authenticated-orcid":false,"given":"Carlos","family":"Moreno-Bernardino","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graciela","family":"Elizabeth De la Mora-Land\u00edn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0257-3107","authenticated-orcid":false,"given":"Amado","family":"Jim\u00e9nez-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0668-0567","authenticated-orcid":false,"given":"Christian","family":"Garc\u00eda-Estrada","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, IMSS Hospital Regional #1, Durango, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lizeth","family":"Zertuche-Ortu\u00f1o","sequence":"additional","affiliation":[{"name":"Centro Medico Naval, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Sald\u00edvar-D\u00e1vila","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Universitario Dr. Jos\u00e9 Eleuterio Gonz\u00e1lez, Monterrey, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2683-5351","authenticated-orcid":false,"given":"Roberto","family":"Rodr\u00edguez-Rivas","sequence":"additional","affiliation":[{"name":"Department Executive and Continuing Professional Education, Harvard University\u2014T.H. Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette","family":"Baz\u00e1n-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, IMSS Hospital General de Zona #2, Hermosillo, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-3009","authenticated-orcid":false,"given":"Jos\u00e9","family":"Flores-Rivera","sequence":"additional","affiliation":[{"name":"Neurology Division, Instituto Nacional de Neurolog\u00eda y Neurocirug\u00eda, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Kalincik","sequence":"additional","affiliation":[{"name":"Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia"},{"name":"CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Buzzard","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Box Hill Hospital, Box Hill, VIC, Australia"},{"name":"Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samia","family":"Khoury","sequence":"additional","affiliation":[{"name":"Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7231-1754","authenticated-orcid":false,"given":"Pierre","family":"Duquette","sequence":"additional","affiliation":[{"name":"CHUM and Universite de Montreal, Montreal, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0321-7155","authenticated-orcid":false,"given":"Matteo","family":"Foschi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, MS Center\u2014Neurology Unit, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy"},{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Surcinelli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, MS Center\u2014Neurology Unit, S. Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6732-151X","authenticated-orcid":false,"given":"Bianca","family":"Weinstock-Guttman","sequence":"additional","affiliation":[{"name":"Jacobs MS Center for Treatment and Research, Buffalo, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riadh","family":"Gouider","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia"},{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saloua","family":"Mrabet","sequence":"additional","affiliation":[{"name":"Department of Neurology, Clinical Investigation Centre Neurosciences and Mental Health, Razi University Hospital, Tunis, Tunisia"},{"name":"Faculty of Medicine 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