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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Fingolimod after natalizumab and the risk of short-term relapse
Neurology, Volume 82, No. 14, Year 2014
Notification
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Description
Objective: To determine early risk of relapse after switch from natalizumab to fingolimod; to compare the switch experience to that in patients switching from interferon-β/glatiramer acetate (IFN-β/GA) and those previously treatment naive; and to determine predictors of time to first relapse on fingolimod. Methods: Data were obtained from the MSBase Registry. Relapse rates (RRs) for each patient group were compared using adjusted negative binomial regression. Survival analyses coupled with adjusted Cox regression were used to model predictors of time to first relapse on fingolimod. Results: A total of 536 patients (natalizumab-fingolimod [n 5 89]; IFN-β/GA-fingolimod [n 5 350]; naive-fingolimod [n 5 97]) were followed up for a median 10 months. In the natalizumab-fingolimod group, there was a small increase in RR on fingolimod (annualized RR [ARR] 0.38) relative to natalizumab (ARR 0.26; p 5 0.002). RRs were generally low across all patient groups in the first 9 months on fingolimod (RR 0.001-0.13). However, 30% of patients with disease activity on natalizumab relapsed within the first 6 months on fingolimod. Independent predictors of time to first relapse on fingolimod were the number of relapses in the prior 6 months (hazard ratio [HR] 1.59 per relapse; p 5 0.002) and a gap in treatment of 2-4 months compared to no gap (HR 2.10; p 5 0.041). Conclusions: RRs after switch to fingolimod were lowin all patient groups. The strongest predictor of relapse on fingolimod was prior relapse activity. Based on our data, we recommend a maximum 2-month treatment gap for switches to fingolimod to decrease the hazard of relapse. Classification of evidence: This study provides Class IV evidence that RRs are not higher in patients with multiple sclerosis switching to fingolimod from natalizumab compared to those patients switching to fingolimod from other therapies. © 2014 American Academy of Neurology.
Authors & Co-Authors
Jokubaitis, Vilija G.
Australia, Melbourne
University of Melbourne
Australia, Melbourne
Royal Melbourne Hospital
Li, Vivien
Australia, Melbourne
Royal Melbourne Hospital
Kalincik, Tomas
Australia, Melbourne
University of Melbourne
Australia, Melbourne
Royal Melbourne Hospital
Izquierdo, Guillermo Ayuso
Spain, Sevilla
Hospital Universitario Virgen Macarena
Hodgkinson, Suzanne J.
Australia, Liverpool
Liverpool Hospital
Alroughani, Raed A.
Kuwait, Safat
Al-amiri Hospital
Lechner-Scott, Jeannette S.
Australia, Newcastle
John Hunter Hospital
Lugaresi, Alessandra
Italy, Chieti
University of G. D'annunzio Chieti and Pescara
Duquette, Pierre Pascal
Canada, Montreal
Hôpital Notre-dame
Girard, Marc
Canada, Montreal
Hôpital Notre-dame
Barnett, Michael H.
Australia, Sydney
The University of Sydney
Grand'Maison, François
Canada, Greenfield Park
Hôpital Charles-le Moyne
Trojano, Maria
Italy, Bari
Università Degli Studi Di Bari Aldo Moro
Slee, Mark
Australia, Adelaide
Flinders University
Giuliani, Giorgio
Italy, Milan
Ospedale Di Macerata
Shaw, Cameron P.
Australia, Geelong
Geelong Hospital
Boz, Cavit
Turkey, Trabzon
Karadeniz Technical University
Spitaleri, Daniele Litterio A.
Italy, Avellino
Aorn San Giuseppe Moscati
Verheul, Freek A.M.
Netherlands, Gouda
Groene Hart Hospital
Haartsen, Jodi
Australia, Clayton
Monash University
Liew, Danny
Australia, Melbourne
University of Melbourne
Butzkueven, Helmut
Australia, Melbourne
University of Melbourne
Australia, Melbourne
Royal Melbourne Hospital
Australia, Clayton
Monash University
Statistics
Citations: 139
Authors: 22
Affiliations: 18
Identifiers
Doi:
10.1212/WNL.0000000000000283
ISSN:
00283878
e-ISSN:
1526632X
Research Areas
Environmental
Health System And Policy