Natalizumab versus fingolimod in subgroups of MS patients

Conference

AAN 2021

An analysis of 3 international cohorts revealed natalizumab to be associated with lower relapse frequency and higher odds of disability improvement than fingolimod. This difference was most pronounced in patients with relapses 12 months prior to starting treatment. Women and patients with lower disability also derived more benefit from natalizumab.

Natalizumab has proven to be more effective than fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (MS) in different studies. The current analysis was performed to assess whether natalizumab is more effective across all patient groups [1]. A total of 5,148 relapsing-remitting MS patients who received treatment with natalizumab (n=1,989) or fingolimod (n=3,159) for at least 3 months were identified in 3 international registries: the French Observatoire of MS, the Danish MS Treatment Register, and the global MSBase registry. Mean age at baseline was 37.91 years; the majority (71.83%) were women. The median on-treatment follow-up was 25.05 months.

A significantly lower on-treatment relapse rate on natalizumab versus fingolimod was observed in patients with the following characteristics:

women (IRR 0.76; 95% CI 0.65–0.88);
age group ≤38 years (0.64; 95% CI 0.54–0.76);
disease duration ≤7 years (0.63; 95% CI 0.53–0.76);
EDSS score ˂4 (0.75; 95% CI 0.64–0.88);
EDSS ˂6 (0.80; 95% CI 0.70–0.91);
EDSS ≥6 (0.52; 95% CI 0.31–0.86);
patients with pre-baseline relapses (0.74; 95% CI 0.64–0.86).

Confirmed disability improvement on natalizumab was more likely in women (OR 1.36; 95% CI 1.10–1.66), age >38 years (1.34; 95% CI 1.04–1.73), disease duration ˃7 years (1.33; 95% CI 1.01–1.74), EDSS score ˂6 (1.21; 95% CI 1.01–1.46), EDSS score ≥6 (1.93; 95% CI 1.11–3.34), and patients without new MRI lesions (1.73; 95% CI 1.19–2.51). In a more progressive MS phenotype, natalizumab and fingolimod showed equal effectiveness.

Sharmin S, et al. Comparative effectiveness of natalizumab and fingolimod in subgroups of patients with relapsing-remitting multiple sclerosis from three international cohorts. P15.073, AAN 2021 Virtual Congress, 17-22 April.

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