Switching to natalizumab or fingolimod in multiple sclerosis: Comparative effectiveness and effect of pre-switch disease activity

Published:December 23, 2022DOI:


      • 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.



      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.


      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.


      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.


      Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab than with fingolimod.



      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)
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