Comparative efficacy of switching to natalizumab in active multiple sclerosis. (27th February 2015)

• Record Type: Journal Article
• Authors: Spelman, Timothy; Kalincik, Tomas; Zhang, Annie; Pellegrini, Fabio; Wiendl, Heinz; Kappos, Ludwig; Tsvetkova, Larisa; Belachew, Shibeshih; Hyde, Robert; Verheul, Freek; Grand‐Maison, Francois; Izquierdo, Guillermo; Grammond, Pierre; Duquette, Pierre; Lugaresi, Alessandra; Lechner‐Scott, Jeannette; Oreja‐Guevara, Celia; Hupperts, Raymond; Petersen, Thor; Barnett, Michael; Trojano, Maria; Butzkueven, Helmut; the MSBase Investigators and the TOP investigators
• Is Part Of: Annals of clinical and translational neurology. Volume 2:Number 4(2015:Apr.)
• Page Start: 373
• Page End: 387
• Publication Date: 2015-02-27
• Subjects: Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8005
• DOI: 10.1002/acn3.180
• Languages: English
• ISSNs: 2328-9503

Abstract

<abstract abstract-type="main" id="acn3180-abs-0001"> <title>Abstract</title> <sec id="acn3180-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare treatment efficacy and persistence in patients who switched to natalizumab versus those who switched between glatiramer acetate (GA) and interferon‐beta (IFN<italic>β</italic>) after an on‐treatment relapse on IFN<italic>β</italic> or GA using propensity score matched real‐world datasets.</p> </sec> <sec id="acn3180-sec-0002" sec-type="section"> <title>Methods</title> <p>Patients included were registered in MSBase or the TYSABRI Observational Program (TOP), had relapsed on IFN<italic>β</italic> or GA within 12 months prior to switching to another therapy, and had initiated natalizumab or IFN<italic>β</italic>/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 (<italic>n</italic> = 869/group) and in subgroups defined by prior treatment history (IFN<italic>β</italic> only [<italic>n</italic> = 578/group], GA only [<italic>n</italic> = 165/group], or both IFN<italic>β</italic> and GA [<italic>n</italic> = 176/group]).</p> </sec> <sec id="acn3180-sec-0003" sec-type="section"> <title>Results</title> <p>Compared to switching between IFN<italic>β</italic> 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 <italic>P </italic>≤<italic> </italic>0.001). In the total population, switching to natalizumab reduced the risk of confirmed disability progression by 26% (<italic>P </italic>=<italic> </italic>0.036) and decreased the total disability burden by 1.54 EDSS‐years (<italic>P </italic><<italic> </italic>0.0001) over the first 24 months post switch.</p> </sec> <sec id="acn3180-sec-0004" sec-type="section"> <title>Interpretation</title> <p>Using large, real‐world, propensity‐matched datasets we demonstrate that after a relapse on IFN<italic>β</italic> or GA, switching to natalizumab (rather than between IFN<italic>β</italic> and GA) led to superior outcomes for patients in all measures assessed. Results were consistent regardless of the prior treatment identity.</p> </sec> </abstract>