Open AccessComparative efficacy of switching to natalizumab in active multiple sclerosis
Author(s) -
Spelman Timothy,
Kalincik Tomas,
Zhang Annie,
Pellegrini Fabio,
Wiendl Heinz,
Kappos Ludwig,
Tsvetkova Larisa,
Belachew Shibeshih,
Hyde Robert,
Verheul Freek,
GrandMaison Francois,
Izquierdo Guillermo,
Grammond Pierre,
Duquette Pierre,
Lugaresi Alessandra,
LechnerScott Jeannette,
OrejaGuevara Celia,
Hupperts Raymond,
Petersen Thor,
Barnett Michael,
Trojano Maria,
Butzkueven Helmut
Publication year - 2015
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.180
Subject(s) - natalizumab , medicine , glatiramer acetate , discontinuation , propensity score matching , multiple sclerosis , population , immunology , environmental health
Objective To compare treatment efficacy and persistence in patients who switched to natalizumab versus those who switched between glatiramer acetate ( GA ) and interferon‐beta ( IFN β ) after an on‐treatment relapse on IFN β or GA using propensity score matched real‐world datasets. Methods Patients included were registered in MSB ase or the TYSABRI Observational Program ( TOP ), had relapsed on IFN β or GA within 12 months prior to switching to another therapy, and had initiated natalizumab or IFN β / GA treatment ≤6 months after discontinuing prior therapy. Covariates were balanced across post switch treatment groups by propensity score matching at treatment initiation. Relapse, persistence, and disability measures were compared between matched treatment arms in the total population ( n = 869/group) and in subgroups defined by prior treatment history ( IFN β only [ n = 578/group], GA only [ n = 165/group], or both IFN β and GA [ n = 176/group]). Results Compared to switching between IFN β and GA , switching to natalizumab reduced annualized relapse rate in year one by 65–75%, the risk of first relapse by 53–82% (mean follow‐up 1.7–2.2 years) and treatment discontinuation events by 48–65% (all P ≤ 0.001). In the total population, switching to natalizumab reduced the risk of confirmed disability progression by 26% ( P = 0.036) and decreased the total disability burden by 1.54 EDSS ‐years ( P < 0.0001) over the first 24 months post switch. Interpretation Using large, real‐world, propensity‐matched datasets we demonstrate that after a relapse on IFN β or GA , switching to natalizumab (rather than between IFN β and GA ) led to superior outcomes for patients in all measures assessed. Results were consistent regardless of the prior treatment identity.