Abstract Details

Title A 2-Stage Model of Heterogenous Treatment Effects for Brain Atrophy in MS Utilizing the MS PATHS Research Network

Topic Multiple Sclerosis

Presentation(s) S27 - MS Neuroimaging (1:00 PM-1:12 PM)

Poster/Presentation
Number 001

Background 2-stage HTE models derived from real-world datasets have the potential to advance personalized medicine in MS. Brain atrophy provides an objective measure benefiting from highly standardized MRI capture.

Objective To extend 2-stage models of heterogenous treatment effect (HTE) to brain atrophy outcomes utilizing the MS PATHS research network.

Design/Methods Analyses included patients in MS PATHS who initiated DMT, had complete baseline data, and ≥1 year follow-up without switching DMT. DMT groups were based on efficacy: high (natalizumab, anti-CD20 monoclonal antibodies, alemtuzumab), moderate (fumarates, S1PR modulators, and cladribine) and low (teriflunomide, interferons, glatiramer acetate). Patients were split into training (70%) and test (30%) sets, stratified by group. In stage one, baseline brain parenchymal fraction (BPF) change risk models were derived by linear mixed effect models with baseline covariates as inputs; performance was assessed by predicted versus actual BPF change R-squared in the test set. In stage 2, propensity score (PS) weighting was performed, using multinomial logistic regression with baseline BPF change risk score as one of the covariates. Average treatment effect (ATE) and HTE were calculated with low-efficacy DMT as the reference.

Results Analyses included 594 high-, 184 moderate-, and 108 low-efficacy DMT-treated patients. Risk model performance R-squared=0.56. After PS adjustment, covariate SMDs were <10%. In the ATE model, moderate- and high-efficacy groups had less brain atrophy than the low-efficacy group (p<0.001). In the HTE model, BPF change was similar across groups for patients with low risk of brain atrophy. In patients with high risk of brain atrophy, high- and moderate-efficacy groups remained similar; the low-efficacy group had 2-fold worse BPF change.

Conclusions HTE models suggest individuals with low baseline risk of brain atrophy may achieve similar outcomes regardless of DMT efficacy choice. The worst relative outcomes occur when patients with high brain atrophy risk are treated with low-efficacy DMTs.

Authors/Disclosures
Carrie M. Hersh, DO, MSc, FAAN (Cleveland Clinic Lou Ruvo Center for Brain Health) PRESENTER	Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech_GN41791. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol-Myers Squibb . Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genzyme. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Hersh has received research support from Biogen. The institution of Dr. Hersh has received research support from Novartis. The institution of Dr. Hersh has received research support from Genentech_GN41791. The institution of Dr. Hersh has received research support from PCORI. The institution of Dr. Hersh has received research support from Bristol Myers Squibb.
	No disclosure on file
Cynthia Grossman	Cynthia Grossman has received personal compensation for serving as an employee of Biogen. Cynthia Grossman has stock in Biogen .
	No disclosure on file
Fabio Pellegrini	Fabio Pellegrini has received personal compensation for serving as an employee of Biogen. Fabio Pellegrini has received stock or an ownership interest from Biogen.
Nolan Campbell	Nolan Campbell has received personal compensation for serving as an employee of Biogen. Nolan Campbell has stock in Biogen.