Highlights
- •Patients switching to natalizumab or fingolimod after ≥1 relapse were matched (1:1)
- •Outcomes were better for RMSS patients switching to natalizumab vs fingolimod
- •Natalizumab patients had lower relapse rates and greater time to first relapse
- •Relapse outcome differences were greatest in those with prior high-relapse activity
Abstract
Background
Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses
on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide;
collectively, “BRACETD”) often switch to another therapy, including natalizumab or
fingolimod. Here we compare the effectiveness of switching from a first-line therapy
to natalizumab or fingolimod after ≥1 relapse.
Methods
Data collected prospectively in the MSBase Registry, a global, longitudinal, observational
registry, were extracted on February 6, 2018. Included patients were adults with RRMS
with ≥1 relapse on BRACETD therapy in the year before switching to natalizumab or
fingolimod. Included patients received natalizumab or fingolimod for ≥3 months after
the switch.
Results
Following 1:1 propensity score matching, 1000 natalizumab patients were matched to
1000 fingolimod patients. Mean (standard deviation) follow-up time was 3.02 (2.06)
years after switching to natalizumab and 2.58 (1.64) years after switching to fingolimod.
Natalizumab recipients had significantly lower annualized relapse rate (relative risk=0.66;
95% confidence interval [CI], 0.59–0.74), lower risk of first relapse (hazard ratio
[HR]=0.69; 95% CI, 0.60–0.80), and higher confirmed disability improvement (HR=1.27;
95% CI, 1.03–1.57) than fingolimod recipients. No difference in confirmed disability
worsening was observed.
Conclusions
Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab
than with fingolimod.
Keywords
Abbreviations:
ARR (annualized relapse rate), BRACETD (Betaseron, Rebif, Avonex, Copaxone, Extavia, Tecfidera, Aubagio), CI (confidence interval), DMT (disease-modifying therapy), EDSS (Expanded Disability Status Scale), HR (hazard ratio), IPTW (inverse-probability-of-treatment-weighting), MRI (magnetic resonance imaging), OFSEP (Observatoire Français de la Sclérose en Plaques), RR (relative risk), RRMS (relapsing-remitting multiple sclerosis), RRR (relapse rate ratio), SD (standard deviation)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
December 22,
2022
Received in revised form:
December 1,
2022
Received:
September 28,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier B.V.
