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

Published:December 23, 2022DOI:https://doi.org/10.1016/j.msard.2022.104477

      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)
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