1Asmaa Eissa, 2Tarek Menecie, 3Hoda Massoud, 2Mohammad Abboud, 2Mohammad H. Rashad

1Nasser institute hospital for research and treatment, Cairo, Egypt; 2Alazhar University, Cairo branch, Egypt; 3Alazhar university (for girls), Cairo branch, Egypt


Early and appropriate treatment decision for multiple sclerosis (MS) can markedly reduce disease activity and accumulation of disability to avoid many of the long-term economic and personal expenses that result from unnecessary irreversible disability. The aim of this study is to describe switching patterns between disease modifying therapies (DMTs) in our local practice and investigate clinical characteristics that could be related to the switching process.

Material(s) and Method(s):

This is a cross-sectional study based on records of 274 MS patients who had been actively receiving available DMTs at the MS unit of Nasser Institute Hospital for Research and Treatment. The data was reviewed and collected using local database registry of the unit in the duration between the year 2016 and 2020.

The patients were classified into three groups: lateral, escalation, and multiple switch groups. The data were collected in the form of patients’ demographics, disease history, switching process data, Expanded Disability Status Scale (EDSS), and Symbol Digit Modality Test (SDMT) values.


A total of 274 MS patients were included in the study: 24.1% were males (n=66) and 75.9% were females (n=208). 43 patients were allocated in the lateral switch group, 178 in the escalation switch group and 53 in the multiple switch group. All baselines characteristics were balanced between the three groups except for (1) the time to switch from previous drug to the new one which was longer in the escalation and multiple switch groups compared to the lateral switch group (1.6 years versus 1.4 years versus 1.2 years, respectively; p-value=0.001), (2) the SDMT score which was significantly different between the three groups (6.5 in the multiple switch group versus 5.8 in the lateral switch group versus 5.3 in the escalation group, p-value <0.001) and (3) the mean EDSS was higher in the multiple switch group compared to the lateral and escalation switch groups (p-value <0.001). Escalation switching was the most frequent strategy of shifting between DMTs (n=178; 65%) with fingolimod being the most common drug switch to in this category. However, interferon beta 1a was the most common drug switched to in the other two groups. The most common
causes for switching DMTs was inefficacy followed by tolerability. Multiple logistic regression analysis was performed to study the association between different variables and both the escalation and multiple switch groups as compared to the lateral switch group. Education level and SDMTs were significantly associated with the escalation switching (p-value= 0.035 and p-value <0.001, respectively) while EDSS and SDMT score were significantly associated with the multiple switching strategy (p-value=0.007 and p-value=0.004, respectively).


This cross sectional Egyptian study revealed that escalation switch was the most prominent switching pattern.The most common cause of switch was the lack of efficacy. The most common drug to be switched from was INF beta 1A sc. The most common drug to be switched to was Fingolimod and INF beta 1A sc, more in escalation group and lateral switch group respectively.

Clinical variables that were significantly associated with the escalation switching were the patient’s education, and SDMT score. The variables that were significantly associated with multiple switching were the EDSS, and SDMT score.