Switching from natalizumab to moderate- versus high-efficacy DMT

Multiple sclerosis (MS) patients switching from natalizumab to another high-efficacy therapy had more favourable inflammatory and disability outcomes after 24 months than patients who deescalated to a moderate-efficacy disease-modifying therapy (DMT), which yielded greater disability progression [1].

The effect of such a treatment change was assessed after 24 months of follow-up. The 556 participants discontinued natalizumab treatment between 2005 and 2018 for various reasons, including progressive multifocal leukoencephalopathy risk (54.9%), breakthrough disease (15.3%), and adverse effects (17.3%). Of those participants, 270 (48.6%) switched to moderate-efficacy DMT (dimethyl fumarate, n=130; fingolimod, n=140), while 130 (23.4%) switched to high-efficacy therapy (ocrelizumab, n=106; rituximab, n=17; alemtuzumab, n=7).

At 24 months, there were no differences in annualised relapse rate (OR 1.44; 95% CI 0.69-1.59; P=0.334). However, a significantly lower proportion of patients in the moderate-efficacy DMT group had no disease activity compared to the high-efficacy therapy group (OR 0.41; 95% CI 0.21-0.71; P=0.004). In the moderate-efficacy DMT group, a significantly higher proportion had:

• new T2 lesions (OR 2.15; 95% CI 1.18-3.01; P=0.011);
• new gadolinium enhancing lesions (OR 1.99; 95% CI 1.12-2.73; P=0.022);
• 20% worsening of the timed 25-foot walk (OR 1.83; 95% CI 1.06-3.02; P=0.043);
• 20% worsening of the 9-hole peg test (OR 1.81; 95% CI 1.05-3.56; P=0.044).

1. Hersh CM, et al. Abstract S29.008, AAN 2020.

Posted on 10 September, 20205 November, 2020