Back to Search
Start Over
Effectiveness and baseline factors associated to fingolimod response in a real-world study on multiple sclerosis patients.
- Source :
-
Journal of neurology [J Neurol] 2018 Apr; Vol. 265 (4), pp. 896-905. Date of Electronic Publication: 2018 Feb 12. - Publication Year :
- 2018
-
Abstract
- Background: Treatment choice in multiple sclerosis (MS) is crucial for optimizing risk-benefit profile.<br />Objective: To assess fingolimod (FTY) effectiveness and identify baseline features associated to disease activity in a large Italian cohort of Relapsing-Remitting (RR) MS patients.<br />Methods: Three-hundred sixty-seven RRMS patients starting FTY treatment at San Raffaele Hospital (Milan-Italy) underwent clinical and MRI evaluations for 2 years. Treatment response was assessed considering the proportion of patients with no evidence of disease activity (NEDA) and recording the time to first relapse. Primary analyses were performed stratifying for Natalizumab (NTZ) treatment in the year before (NO&#95;NTZ vs NTZ group), to account for post-NTZ reactivation.<br />Results: Almost half of patients were NEDA after 2 years, 53.4% in the NO&#95;NTZ group and 36.2% in the NTZ group. Despite an opposite trend during the first 6-12 months, at 2-year follow-up the two groups were comparable for relapses and number of new/enlarging T2 and Gd-enhancing lesions. Baseline parameters of higher disease activity (ARR, Gd enhancing lesions and age at onset) were associated with increased likelihood of failing NEDA criteria or with shorter time to relapse (p < 0.05).<br />Conclusions: Our data strengthen FTY effectiveness in everyday clinical practice, even in patients switching from NTZ treatment. Baseline parameters of inflammatory activity are the most important prognostic factors for mid-term disease reactivation also during second-line treatment with FTY, providing hints on how to select therapies towards a more personalized management.
- Subjects :
- Adult
Antibodies, Monoclonal, Humanized therapeutic use
Brain diagnostic imaging
Cohort Studies
Disability Evaluation
Female
Gadolinium pharmacokinetics
Humans
Italy
Magnetic Resonance Imaging
Male
Middle Aged
Multiple Sclerosis diagnostic imaging
Natalizumab therapeutic use
Time Factors
Fingolimod Hydrochloride therapeutic use
Immunosuppressive Agents therapeutic use
Multiple Sclerosis drug therapy
Treatment Outcome
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1459
- Volume :
- 265
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of neurology
- Publication Type :
- Academic Journal
- Accession number :
- 29435643
- Full Text :
- https://doi.org/10.1007/s00415-018-8791-1