1. Comparison Between Dimethyl Fumarate, Fingolimod, and Ocrelizumab After Natalizumab Cessation
- Author
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Zhu, C, Kalincik, T, Horakova, D, Zhou, Z, Buzzard, K, Skibina, O, Alroughani, R, Izquierdo, G, Eichau, S, Kuhle, J, Patti, F, Grand'Maison, F, Hodgkinson, S, Grammond, P, Lechner-Scott, J, Butler, E, Prat, A, Girard, M, Duquette, P, Macdonell, RAL, Weinstock-Guttman, B, Ozakbas, S, Slee, M, Sa, MJ, Van Pesch, V, Barnett, M, Van Wijmeersch, B, Gerlach, O, Prevost, J, Terzi, M, Boz, C, Laureys, G, Van Hijfte, L, Kermode, AG, Garber, J, Yamout, B, Khoury, SJ, Merlo, D, Monif, M, Jokubaitis, V, van der Walt, A, Butzkueven, H, MSBase, SG, Zhu, C, Kalincik, T, Horakova, D, Zhou, Z, Buzzard, K, Skibina, O, Alroughani, R, Izquierdo, G, Eichau, S, Kuhle, J, Patti, F, Grand'Maison, F, Hodgkinson, S, Grammond, P, Lechner-Scott, J, Butler, E, Prat, A, Girard, M, Duquette, P, Macdonell, RAL, Weinstock-Guttman, B, Ozakbas, S, Slee, M, Sa, MJ, Van Pesch, V, Barnett, M, Van Wijmeersch, B, Gerlach, O, Prevost, J, Terzi, M, Boz, C, Laureys, G, Van Hijfte, L, Kermode, AG, Garber, J, Yamout, B, Khoury, SJ, Merlo, D, Monif, M, Jokubaitis, V, van der Walt, A, Butzkueven, H, and MSBase, SG
- Abstract
IMPORTANCE: Natalizumab cessation is associated with a risk of rebound disease activity. It is important to identify the optimal switch disease-modifying therapy strategy after natalizumab to limit the risk of severe relapses. OBJECTIVES: To compare the effectiveness and persistence of dimethyl fumarate, fingolimod, and ocrelizumab among patients with relapsing-remitting multiple sclerosis (RRMS) who discontinued natalizumab. DESIGN, SETTING, AND PARTICIPANTS: In this observational cohort study, patient data were collected from the MSBase registry between June 15, 2010, and July 6, 2021. The median follow-up was 2.7 years. This was a multicenter study that included patients with RRMS who had used natalizumab for 6 months or longer and then were switched to dimethyl fumarate, fingolimod, or ocrelizumab within 3 months after natalizumab discontinuation. Patients without baseline data were excluded from the analysis. Data were analyzed from May 24, 2022, to January 9, 2023. EXPOSURES: Dimethyl fumarate, fingolimod, and ocrelizumab. MAIN OUTCOMES AND MEASURES: Primary outcomes were annualized relapse rate (ARR) and time to first relapse. Secondary outcomes were confirmed disability accumulation, disability improvement, and subsequent treatment discontinuation, with the comparisons for the first 2 limited to fingolimod and ocrelizumab due to the small number of patients taking dimethyl fumarate. The associations were analyzed after balancing covariates using an inverse probability of treatment weighting method. RESULTS: Among 66 840 patients with RRMS, 1744 had used natalizumab for 6 months or longer and were switched to dimethyl fumarate, fingolimod, or ocrelizumab within 3 months of natalizumab discontinuation. After excluding 358 patients without baseline data, a total of 1386 patients (mean [SD] age, 41.3 [10.6] years; 990 female [71%]) switched to dimethyl fumarate (138 [9.9%]), fingolimod (823 [59.4%]), or ocrelizumab (425 [30.7%]) after natalizumab. The ARR for ea
- Published
- 2023