Switching to natalizumab or fingolimod in multiple sclerosis: Comparative effectiveness and effect of pre-switch disease activity.

Background: Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide; collectively, "BRACETD") often switch to another therapy, including natalizumab or fingolimod. Here we compare the effectiveness of switching from a first-line therapy to natalizumab or fingolimod after ≥1 relapse.
Methods: Data collected prospectively in the MSBase Registry, a global, longitudinal, observational registry, were extracted on February 6, 2018. Included patients were adults with RRMS with ≥1 relapse on BRACETD therapy in the year before switching to natalizumab or fingolimod. Included patients received natalizumab or fingolimod for ≥3 months after the switch.
Results: Following 1:1 propensity score matching, 1000 natalizumab patients were matched to 1000 fingolimod patients. Mean (standard deviation) follow-up time was 3.02 (2.06) years after switching to natalizumab and 2.58 (1.64) years after switching to fingolimod. Natalizumab recipients had significantly lower annualized relapse rate (relative risk=0.66; 95% confidence interval [CI], 0.59-0.74), lower risk of first relapse (hazard ratio [HR]=0.69; 95% CI, 0.60-0.80), and higher confirmed disability improvement (HR=1.27; 95% CI, 1.03-1.57) than fingolimod recipients. No difference in confirmed disability worsening was observed.
Conclusions: Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab than with fingolimod.
Competing Interests: Declaration of Competing Interest Dr Spelman has received honoraria for consultancy and funding for travel from Biogen and Novartis. Dr Horakova has received speaker honoraria and consulting fees from Biogen, Merck, Novartis, Roche, Sanofi Genzyme, and Teva, as well as support for research activities from Biogen and the Czech Ministry of Education (project Progres Q27/LF1). Dr Alroughani has received honoraria as a speaker and for serving on scientific advisory boards from Bayer, Biogen, GSK, Merck, Novartis, Roche, and Sanofi Genzyme. Dr Kalincik has served on scientific advisory boards for Biogen, Merck, Novartis, Roche, and Sanofi Genzyme and a steering committee for Genzyme's Brain Atrophy Initiative; has received conference travel support and/or speaker honoraria from BioCSL, Biogen, Merck, Novartis, Sanofi Genzyme, Teva, and WebMD Global; and has received research support from Biogen. Dr Terzi has received travel grants from Bayer Schering, Merck, Novartis, and Teva and has participated in clinical trials by Novartis, Roche, and Sanofi. Dr Grammond has served on advisory boards for Biogen, Genzyme, Merck, Novartis, and Teva Neuroscience and as a consultant for Merck; has received payments for lectures from Merck, Teva Neuroscience, and the Canadian Multiple Sclerosis Society; and has received grants for travel from Novartis and Teva Neuroscience. Dr Patti has received speaker honoraria or advisory board fees from Almirall, Bayer, Biogen, Celgene, Merck, Mylan, Novartis, Roche, Sanofi Genzyme, and Teva and research funding from Biogen, Merck, the Italian Ministry of Education, University and Research, and the Italian Multiple Sclerosis Society Foundation. Dr Csepany has received speaker honoraria and/or conference travel support from Bayer Schering, Biogen, Merck, Novartis, Roche, Sanofi, and Teva. Dr Boz has received conference travel support from Bayer Schering, Biogen, Merck, Novartis, and Teva and has participated in clinical trials by Novartis, Roche, and Sanofi. Dr Lechner-Scott has received travel compensation from Biogen, Merck, and Novartis and has been involved in clinical trials with Biogen, Novartis, and Teva. Her institution has received honoraria for talks and advisory board service from Bayer HealthCare, Biogen, Merck, Novartis, Sanofi Genzyme, and Teva. Dr Granella has received research funding from Biogen and Sanofi Genzyme; fees for advisory boards and speaker honoraria from Biogen, Merck Serono, Novartis, Roche, and Sanofi Genzyme; and travel funding from Biogen, Merck Serono, Roche, and Sanofi Genzyme. Dr Grand'Maison has received honoraria or research funding from Biogen, Genzyme, Mitsubishi, Novartis, Ono Pharmaceuticals, and Teva Neuroscience. Dr. van der Walt reports grants from Roche and Novartis; and has served on advisory boards for and received travel support from Merck, Roche, Biogen, Novartis, Alexion, and BMS. Dr Butzkueven has served on scientific advisory boards for Biogen, Novartis, and Sanofi and steering committees for trials conducted by Biogen and Novartis; has received conference travel support from Biogen, Novartis, and Sanofi; and has received research support from Biogen, Merck, and Novartis. Drs Ozakbas, Onofrj, Prat, and Zhu have nothing to disclose.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)