- Title
- Switch to natalizumab versus fingolimod in active relapsing-remitting multiple sclerosis
- Creator
- Kalincik, Tomas; Horakova, Dana; Spelman, Tim; Jokubaitis, Vilija; Trojano, Maria; Lugaresi, Alessandra; Izquierdo, Guillermo; Rozsa, Csilla; Grammond, Pierre; Alroughani, Raed; Duquette, Pierre; Girard, Marc; Pucci, Eugenio; Lechner-Scott, Jeannette; Slee, Mark; Fernandez-Bolanos, Ricardo; Grand'Maison, Francois; Hupperts, Raymond; Verheul, Freek; Hodgkinson, Suzanne
- Relation
- NHMRC.1071124, NHMRC.628856, NHMRC.1032484 & NHMRC.1001216 http://purl.org/au-research/grants/nhmrc/1001216
- Relation
- Annals of Neurology Vol. 77, Issue 3, p. 425-435
- Publisher Link
- http://dx.doi.org/10.1002/ana.24339
- Publisher
- John Wiley & Sons
- Resource Type
- journal article
- Date
- 2015
- Description
- Objective: In patients suffering multiple sclerosis activity despite treatment with interferon β or glatiramer acetate, clinicians often switch therapy to either natalizumab or fingolimod. However, no studies have directly compared the outcomes of switching to either of these agents. Methods: Using MSBase, a large international, observational, prospectively acquired cohort study, we identified patients with relapsing-remitting multiple sclerosis experiencing relapses or disability progression within the 6 months immediately preceding switch to either natalizumab or fingolimod. Quasi-randomization with propensity score-based matching was used to select subpopulations with comparable baseline characteristics. Relapse and disability outcomes were compared in paired, pairwise-censored analyses. Results: Of the 792 included patients, 578 patients were matched (natalizumab, n = 407; fingolimod, n = 171). Mean on-study follow-up was 12 months. The annualized relapse rates decreased from 1.5 to 0.2 on natalizumab and from 1.3 to 0.4 on fingolimod, with 50% relative postswitch difference in relapse hazard (p = 0.002). A 2.8 times higher rate of sustained disability regression was observed after the switch to natalizumab in comparison to fingolimod (p<0.001). No difference in the rate of sustained disability progression events was observed between the groups. The change in overall disability burden (quantified as area under the disability-time curve) differed between natalizumab and fingolimod (20.12 vs 0.04 per year, respectively, p<0.001). Interpretation: This study suggests that in active multiple sclerosis during treatment with injectable disease-modifying therapies, switching to natalizumab is more effective than switching to fingolimod in reducing relapse rate and short-term disability burden.
- Subject
- multiple sclerosis; interferon β; natalizumab; fingolimod
- Identifier
- http://hdl.handle.net/1959.13/1335092
- Identifier
- uon:27384
- Identifier
- ISSN:0364-5134
- Language
- eng
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