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Comparative analysis of natalizumab versus fingolimod as second-line treatment in relapsing-remitting multiple sclerosis.
Mult Scler. 2018 05; 24(6):777-785.MS

Abstract

BACKGROUND

No randomized controlled trials have compared the efficacy of fingolimod or natalizumab as second-line treatment in patients with relapsing-remitting multiple sclerosis (RRMS).

OBJECTIVE

To compare clinical outcomes after escalation to fingolimod versus natalizumab in patients with clinically active RRMS.

METHODS

Using the registry of the Swiss Federation for Common Tasks of Health Insurances, we identified patients with RRMS and ≥1 relapse in the year before switching from interferon beta or glatiramer acetate to fingolimod or natalizumab. Propensity score matching was used to select patients with comparable baseline characteristics. Relapse and Expanded Disability Status Scale (EDSS) outcomes were compared in paired, pairwise-censored analyses.

RESULTS

Of the 547 included patients, 358 were matched (fingolimod, n = 179; natalizumab, n = 179). Median follow-up time was 1.8 years (interquartile range 0.9-2.9). Patients switching to natalizumab had a lower risk of relapses (incidence rate ratio 0.5, 95% confidence interval (CI) 0.3-0.8, p = 0.001) and were more likely to experience EDSS improvement (hazard ratio (HR) 1.8, 95% CI 1.1-2.7, p = 0.01) compared to fingolimod. We found no differences in the proportion of patients free from EDSS progression (HR 0.9, 95% CI 0.5-1.5, p = 0.62).

CONCLUSION

Natalizumab seems to be more effective in reducing relapse rate and improving disability compared with fingolimod.

Authors+Show Affiliations

Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland.Clinical Trial Unit, University Hospital Basel, Basel, Switzerland.Rheinburg-Klinik, Walzenhausen, Switzerland.Swiss Federation for Common Tasks of Health Insurances (SVK), Solothurn, Switzerland.Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland.Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland.Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland.Neurologic Clinic and Policlinic, Department of Neurology, University Hospital Basel, Basel, Switzerland.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

29685071

Citation

Lorscheider, Johannes, et al. "Comparative Analysis of Natalizumab Versus Fingolimod as Second-line Treatment in Relapsing-remitting Multiple Sclerosis." Multiple Sclerosis (Houndmills, Basingstoke, England), vol. 24, no. 6, 2018, pp. 777-785.
Lorscheider J, Benkert P, Lienert C, et al. Comparative analysis of natalizumab versus fingolimod as second-line treatment in relapsing-remitting multiple sclerosis. Mult Scler. 2018;24(6):777-785.
Lorscheider, J., Benkert, P., Lienert, C., Hänni, P., Derfuss, T., Kuhle, J., Kappos, L., & Yaldizli, Ö. (2018). Comparative analysis of natalizumab versus fingolimod as second-line treatment in relapsing-remitting multiple sclerosis. Multiple Sclerosis (Houndmills, Basingstoke, England), 24(6), 777-785. https://doi.org/10.1177/1352458518768433
Lorscheider J, et al. Comparative Analysis of Natalizumab Versus Fingolimod as Second-line Treatment in Relapsing-remitting Multiple Sclerosis. Mult Scler. 2018;24(6):777-785. PubMed PMID: 29685071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative analysis of natalizumab versus fingolimod as second-line treatment in relapsing-remitting multiple sclerosis. AU - Lorscheider,Johannes, AU - Benkert,Pascal, AU - Lienert,Carmen, AU - Hänni,Peter, AU - Derfuss,Tobias, AU - Kuhle,Jens, AU - Kappos,Ludwig, AU - Yaldizli,Özgür, Y1 - 2018/04/24/ PY - 2018/4/25/pubmed PY - 2019/9/7/medline PY - 2018/4/25/entrez KW - Multiple sclerosis KW - disability progression KW - fingolimod KW - natalizumab KW - observational study KW - relapse rate SP - 777 EP - 785 JF - Multiple sclerosis (Houndmills, Basingstoke, England) JO - Mult. Scler. VL - 24 IS - 6 N2 - BACKGROUND: No randomized controlled trials have compared the efficacy of fingolimod or natalizumab as second-line treatment in patients with relapsing-remitting multiple sclerosis (RRMS). OBJECTIVE: To compare clinical outcomes after escalation to fingolimod versus natalizumab in patients with clinically active RRMS. METHODS: Using the registry of the Swiss Federation for Common Tasks of Health Insurances, we identified patients with RRMS and ≥1 relapse in the year before switching from interferon beta or glatiramer acetate to fingolimod or natalizumab. Propensity score matching was used to select patients with comparable baseline characteristics. Relapse and Expanded Disability Status Scale (EDSS) outcomes were compared in paired, pairwise-censored analyses. RESULTS: Of the 547 included patients, 358 were matched (fingolimod, n = 179; natalizumab, n = 179). Median follow-up time was 1.8 years (interquartile range 0.9-2.9). Patients switching to natalizumab had a lower risk of relapses (incidence rate ratio 0.5, 95% confidence interval (CI) 0.3-0.8, p = 0.001) and were more likely to experience EDSS improvement (hazard ratio (HR) 1.8, 95% CI 1.1-2.7, p = 0.01) compared to fingolimod. We found no differences in the proportion of patients free from EDSS progression (HR 0.9, 95% CI 0.5-1.5, p = 0.62). CONCLUSION: Natalizumab seems to be more effective in reducing relapse rate and improving disability compared with fingolimod. SN - 1477-0970 UR - https://www.unboundmedicine.com/medline/citation/29685071/Comparative_analysis_of_natalizumab_versus_fingolimod_as_second_line_treatment_in_relapsing_remitting_multiple_sclerosis_ L2 - http://journals.sagepub.com/doi/full/10.1177/1352458518768433?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -