Please use this identifier to cite or link to this item:
Title: Comparing switch to ocrelizumab, cladribine or natalizumab after fingolimod treatment cessation in multiple sclerosis.
Austin Authors: Zhu, Chao;Zhou, Zhen;Roos, Izanne;Merlo, Daniel;Kalincik, Tomas;Ozakbas, Serkan;Skibina, Olga;Kuhle, Jens;Hodgkinson, Suzanne;Boz, Cavit;Alroughani, Raed;Lechner-Scott, Jeannette;Barnett, Michael;Izquierdo, Guillermo;Prat, Alexandre;Horakova, Dana;Kubala Havrdova, Eva;Macdonell, Richard A L ;Patti, Francesco;Khoury, Samia Joseph;Slee, Mark;Karabudak, Rana;Onofrj, Marco;Van Pesch, Vincent;Prevost, Julie;Monif, Mastura;Jokubaitis, Vilija;van der Walt, Anneke;Butzkueven, Helmut
Affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
Clinical Outcomes Research Unit, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
Departments of Nephrology and Neurology, Liverpool Hospital, Sydney, New South Wales, Australia
Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
School of Medicine and Public Health, University Newcastle, Newcastle, New South Wales, Australia
Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
Austin Health
Flinders University, Adelaide, South Australia, Australia
Dokuz Eylul University, İzmir, Turkey.
Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland..
KTU Medical Faculty Farabi Hospital, Trabzon, Turkey.
Division of Neurology, Amiri Hospital, Sharq, Kuwait.
Hospital Universitario Virgen Macarena, Sevilla, Spain.
Hôpital Notre Dame, CHUM and Universite de Montreal, Montreal, Québec, Canada..
Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic..
Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.. Multiple Sclerosis Center, University of Catania, Catania, Italy..
Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon..
Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey..
Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy..
Cliniques Universitaires Saint-Luc, Brussels, Belgium..
Centre integre de sante et de services sociaux des Laurentides point de service de Saint-Jerome, Saint-Jerome, Quebec, Canada..
Issue Date: 19-Oct-2022 2022
Publication information: Journal of Neurology, Neurosurgery, and Psychiatry 2022; 93(12).
Abstract: To compare the effectiveness and treatment persistence of ocrelizumab, cladribine and natalizumab in patients with relapsing-remitting multiple sclerosis switching from fingolimod. Using data from MSBase registry, this multicentre cohort study included subjects who had used fingolimod for ≥6 months and then switched to ocrelizumab, cladribine or natalizumab within 3 months after fingolimod discontinuation. We analysed relapse and disability outcomes after balancing covariates using an inverse-probability-treatment-weighting method. Propensity scores for the three treatments were obtained using multinomial-logistic regression. Due to the smaller number of cladribine users, comparisons of disability outcomes were limited to natalizumab and ocrelizumab. Overall, 1045 patients switched to ocrelizumab (n=445), cladribine (n=76) or natalizumab (n=524) after fingolimod. The annualised relapse rate (ARR) for ocrelizumab was 0.07, natalizumab 0.11 and cladribine 0.25. Compared with natalizumab, the ARR ratio (95% confidence interval [CI]) was 0.67 (0.47 to 0.96) for ocrelizumab and 2.31 (1.30 to 4.10) for cladribine; the hazard ratio (95% CI) for time to first relapse was 0.57 (0.40 to 0.83) for ocrelizumab and 1.18 (0.47 to 2.93) for cladribine. Ocrelizumab users had an 89% lower discontinuation rate (95% CI, 0.07 to 0.20) than natalizumab, but also a 51% lower probability of confirmed disability improvement (95% CI, 0.32 to 0.73). There was no difference in disability accumulation. After fingolimod cessation, ocrelizumab and natalizumab were more effective in reducing relapses than cladribine. Due to the low ARRs in all three treatment groups, additional observation time is required to determine if statistical difference in ARRs results in long-term disability differences.
DOI: 10.1136/jnnp-2022-330104
ORCID: 0000-0003-3951-7501
Journal: Journal of Neurology, Neurosurgery, and Psychiatry
PubMed URL: 36261289
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Jun 9, 2023

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.