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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