Comparing switch to ocrelizumab, cladribine or natalizumab after fingolimod treatment cessation in multiple sclerosis.

2022-10-19

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

MULTIPLE SCLEROSIS

NEUROIMMUNOLOGY

Journal Article

0000-0003-3951-7501

0000-0003-0371-3666

0000-0003-3778-1376

0000-0002-2156-8864

0000-0003-3198-6063

0000-0002-0480-2495

0000-0002-3942-4340

0000-0002-4278-7003

10.1136/jnnp-2022-330104

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.

link

Journal of Neurology, Neurosurgery, and Psychiatry 2022; 93(12).

Journal of Neurology, Neurosurgery, and Psychiatry