1
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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. Comparison Between Dimethyl Fumarate, Fingolimod, and Ocrelizumab After Natalizumab Cessation. JAMA Neurol 2023; 80:739-748. [PMID: 37273217 PMCID: PMC10242509 DOI: 10.1001/jamaneurol.2023.1542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/27/2023] [Indexed: 06/06/2023]
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 each medication was as follows: ocrelizumab, 0.06 (95% CI, 0.04-0.08); fingolimod, 0.26 (95% CI, 0.12-0.48); and dimethyl fumarate, 0.27 (95% CI, 0.12-0.56). The ARR ratio of fingolimod to ocrelizumab was 4.33 (95% CI, 3.12-6.01) and of dimethyl fumarate to ocrelizumab was 4.50 (95% CI, 2.89-7.03). Compared with ocrelizumab, the hazard ratio (HR) of time to first relapse was 4.02 (95% CI, 2.83-5.70) for fingolimod and 3.70 (95% CI, 2.35-5.84) for dimethyl fumarate. The HR of treatment discontinuation was 2.57 (95% CI, 1.74-3.80) for fingolimod and 4.26 (95% CI, 2.65-6.84) for dimethyl fumarate. Fingolimod use was associated with a 49% higher risk for disability accumulation compared with ocrelizumab. There was no significant difference in disability improvement rates between fingolimod and ocrelizumab. Conclusion and Relevance Study results show that among patients with RRMS who switched from natalizumab to dimethyl fumarate, fingolimod, or ocrelizumab, ocrelizumab use was associated with the lowest ARR and discontinuation rates, and the longest time to first relapse.
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Affiliation(s)
- Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tomas Kalincik
- Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Dana Horakova
- Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katherine Buzzard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Olga Skibina
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jens Kuhle
- University Hospital and University of Basel, Basel, Switzerland
| | - Francesco Patti
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | | | | | | | | | - Ernest Butler
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Alexandre Prat
- CHUM MS Center and Université de Montréal, Montréal, Québec, Canada
| | - Marc Girard
- CHUM MS Center and Université de Montréal, Montréal, Québec, Canada
| | - Pierre Duquette
- CHUM MS Center and Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Maria Jose Sa
- Centro Hospitalar Universitario de São João, Porto, Portugal
| | | | | | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Oliver Gerlach
- Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | | | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | - Allan G. Kermode
- University of Western Australia, Nedlands, Western Australia, Australia
| | - Justin Garber
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Bassem Yamout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J. Khoury
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
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2
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Hersh CM, Harris H, Conway D, Hua LH. Effect of switching from natalizumab to moderate- vs high-efficacy DMT in clinical practice. Neurol Clin Pract 2021; 10:e53-e65. [PMID: 33510948 PMCID: PMC7837445 DOI: 10.1212/cpj.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess the real-world comparative effectiveness of switching from natalizumab (NTZ) to a moderate-efficacy (Mod) disease-modifying therapy (DMT) vs high-efficacy therapy (HET) in patients with multiple sclerosis (MS). Methods Patients discontinuing NTZ at two MS centers (n = 556) who switched to Mod DMT (n = 270) vs HET (n = 130) were assessed using propensity score (PS) weighting. PS model covariates included demographics and baseline clinical and MRI characteristics. All outcomes were reported as Mod DMT vs HET. Results Of the patients included in the study, 48.6% switched to Mod DMT (dimethyl fumarate, n = 130; fingolimod, n = 140) vs 23.4% who switched to HET (ocrelizumab, n = 106; rituximab, n = 17; alemtuzumab, n = 7). Within the first 6 months post-NTZ, switchers to Mod DMT experienced comparable relapses (odds ratio [OR] = 1.36, 95% confidence interval [CI] [0.72-1.66], p = 0.724), although they had increased MRI activity on treatment (OR = 2.59, 95% CI [1.09-3.57], p = 0.037). By 24 months post-NTZ, there was no difference in the annualized relapse rate (OR = 1.44, 95% CI [0.69-1.59], p = 0.334) or time to first clinical relapse (HR = 2.12, 95% CI [0.87-5.17], p = 0.090), although switchers to Mod DMT had higher gadolinium-enhancing (GdE) lesions (OR = 3.62, 95% CI [1.56-5.21], p = 0.005), earlier time to first GdE lesion (HR = 6.67, 95% CI [2.06-9.16], p = 0.002), lower proportion with the absence of disease activity (OR = 0.41, 95% CI [0.21-0.71], p = 0.004), and higher risk of disability progression on T25FW (OR = 1.83, 95% CI [1.06-3.02], p = 0.043) and 9-HPT (OR = 1.81, 95% CI [1.05-3.56], p = 0.044). Conclusion Patients switching from NTZ to Mod DMT vs HET were at relatively increased risk of disease activity within the first 6 months of NTZ withdrawal that was sustained at 24 months, yielding greater disability progression.
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Affiliation(s)
- Carrie M Hersh
- Lou Ruvo Center for Brain Health (CMH, HH, LHH), Cleveland Clinic, Las Vegas, NV; and Mellen Center for Multiple Sclerosis Treatment and Research (DC), Cleveland Clinic, Cleveland, OH
| | - Haleigh Harris
- Lou Ruvo Center for Brain Health (CMH, HH, LHH), Cleveland Clinic, Las Vegas, NV; and Mellen Center for Multiple Sclerosis Treatment and Research (DC), Cleveland Clinic, Cleveland, OH
| | - Devon Conway
- Lou Ruvo Center for Brain Health (CMH, HH, LHH), Cleveland Clinic, Las Vegas, NV; and Mellen Center for Multiple Sclerosis Treatment and Research (DC), Cleveland Clinic, Cleveland, OH
| | - Le H Hua
- Lou Ruvo Center for Brain Health (CMH, HH, LHH), Cleveland Clinic, Las Vegas, NV; and Mellen Center for Multiple Sclerosis Treatment and Research (DC), Cleveland Clinic, Cleveland, OH
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Comi G, Pozzilli C, Morra VB, Bertolotto A, Sangalli F, Prosperini L, Carotenuto A, Iaffaldano P, Capobianco M, Colombo D, Nica M, Rizzoli S, Trojano M. Effectiveness of fingolimod in real-world relapsing-remitting multiple sclerosis Italian patients: the GENIUS study. Neurol Sci 2020; 41:2843-2851. [PMID: 32318950 PMCID: PMC7479005 DOI: 10.1007/s10072-020-04380-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/27/2020] [Indexed: 01/21/2023]
Abstract
Background Fingolimod is the first oral agent approved for treatment of relapsing-remitting multiple sclerosis (RRMS). We aimed to evaluate fingolimod effectiveness in a real-world sample of RRMS patients. Methods A retrospective, multicentre study in patients treated with fingolimod, whom clinical and radiological data were collected in the 2 years preceding and following the initiation of fingolimod. Results Out of 414 patients, 56.8% received prior first-line injectable disease-modifying therapies, 25.4% were previously treated with natalizumab, 1.2% with immunosuppressant agents, and 16.7% were treatment naive. The annualized relapse rate decreased by 65% in the first year and by 70% after two years of treatment. Age ≤ 40 years, ≥ 1 relapse in the 24 months before fingolimod initiation and previous treatment with natalizumab were risk factors for relapses. Overall, 67.9% patients had no evidence of disease activity (NEDA-3) after 1 year and 54.6% after 2 years of treatment. A higher proportion of naïve (81.2% in 1 year and 66.7% after 2 years) or first-line injected patients (70.2% and 56.6%) achieved NEDA-3 than those previously treated with natalizumab (54.3% and 42.9%). Conclusions Fingolimod appeared to be effective in naive patients and after first-line treatment failure in reducing risk of relapse and disease activity throughout the 2-year follow-up. Electronic supplementary material The online version of this article (10.1007/s10072-020-04380-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University, Rome, Italy.,Multiple Sclerosis Center, S. Andrea Hospital, Rome, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | | | - Luca Prosperini
- Multiple Sclerosis Center, S. Andrea Hospital, Rome, Italy.,Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | | | | | | | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Gross RH, Corboy JR. Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies. Continuum (Minneap Minn) 2019; 25:715-735. [PMID: 31162313 DOI: 10.1212/con.0000000000000738] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This article reviews appropriate monitoring of the various multiple sclerosis (MS) disease-modifying therapies, summarizes the reasons patients switch or stop treatment, and provides a framework for making these management decisions. RECENT FINDINGS With the increasing number of highly effective immunotherapies available for MS, the possibility of better control of the disease has increased, but with it, the potential for side effects has rendered treatment decisions more complicated. Starting treatment early with more effective and better-tolerated disease-modifying therapies reduces the likelihood of switching because of breakthrough disease or lack of compliance. Clinical and radiographic surveillance, and often blood and other paraclinical tests, should be performed periodically, depending on the disease-modifying therapy. Helping patients navigate the uncertainty around switching or stopping treatment, either temporarily or permanently, is one of the most important things we do as providers of MS care. SUMMARY Ongoing monitoring of drug therapy is a crucial component of long-term MS care. Switching treatments may be necessary for a variety of reasons. Permanent discontinuation of treatment may be appropriate for some patients with MS, although more study is needed in this area.
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Ziemssen T, Lang M, Tackenberg B, Schmidt S, Albrecht H, Klotz L, Haas J, Lassek C, Cornelissen C, Ettle B. Long-term real-world evidence for sustained clinical benefits of fingolimod following switch from natalizumab. Mult Scler Relat Disord 2019; 39:101893. [PMID: 31865273 DOI: 10.1016/j.msard.2019.101893] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The risk of progressive multifocal leukoencephalopathy limits the duration over which patients can receive natalizumab before requiring a switch to other therapies such as fingolimod. To date, no studies have assessed the long-term real-world effectiveness and safety of fingolimod following a switch from natalizumab. We aimed to investigate the benefit-risk profile of fingolimod over 48 months in patients switching from natalizumab, and the impact of washout duration after natalizumab discontinuation on outcomes during fingolimod treatment. METHODS This analysis used data from PANGAEA, an ongoing German multicenter, prospective, non-interventional, observational study. In total, 3912 patients were included: 530 had switched from natalizumab (natalizumab subpopulation), and a reference population of 3382 had switched from other treatments or were treatment-naïve (non-natalizumab subpopulation). The natalizumab subpopulation was stratified by washout duration (30-89 days, 90-149 days, and ≥ 150 days) prior to fingolimod initiation. RESULTS In the natalizumab subpopulation over 48 months of fingolimod treatment, 58.2% (n = 227/390) of patients remained on fingolimod. Over this period, mean annualized relapse rates (ARRs) and proportions of patients who relapsed were similar across washout durations, and ranged from 0.455 (95% confidence interval [CI]: 0.363-0.571) to 0.546 (95% CI: 0.446-0.669) and 54.1% (n = 92/170) to 60.2% (n = 127/211), respectively. Overall, 17.1% (n = 36/211) had 6-month confirmed disability worsening. In the non-natalizumab subpopulation, ARR was 0.300, 40.9% (n = 1325/3237) of patients relapsed, and a similar proportion to the natalizumab subpopulation had 6-month disability worsening (16.6% [n = 232/1394]). In both subpopulations, the safety profile of fingolimod was consistent with that observed in randomized controlled trials. CONCLUSIONS In patients discontinuing natalizumab, fingolimod has a favorable benefit-risk profile over 48 months. These findings also suggest using a short washout following natalizumab discontinuation, consistent with guidelines and current clinical practice in Germany.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, University of Technology, Dresden, D-01307, Germany.
| | - Michael Lang
- NeuroPoint Patient Academy and Neurological Practice, Ulm, Germany.
| | - Björn Tackenberg
- Department of Neurology, Center of Neuroimmunology, Philipps-University, Marburg, Germany.
| | | | | | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Münster, Germany.
| | - Judith Haas
- Centre for Multiple Sclerosis, Jewish Hospital Berlin, Berlin, Germany.
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6
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Guger M, Enzinger C, Leutmezer F, Kraus J, Kalcher S, Kvas E, Berger T. Switching from natalizumab to fingolimod treatment in multiple sclerosis: real life data from the Austrian MS Treatment Registry. J Neurol 2019; 266:2672-2677. [PMID: 31312958 DOI: 10.1007/s00415-019-09464-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare the efficacy of natalizumab (NTZ) and fingolimod (FTY) in the treatment of relapsing-remitting multiple sclerosis (MS) in sequential use in common and as a function of transition periods in a nationwide observational cohort using prospectively collected data from a real-life setting. MATERIALS AND METHODS We included 195 patients from the Austrian MS Treatment Registry, who had started treatment with NTZ at any time since 2006 and stayed on NTZ for at least 24 months, switched afterwards within 1 year to FTY and stayed on FTY for at least another 12 months. Transition periods between NTZ and FTY were grouped into three different intervals: < 3 months (135 patients), 3-6 months (44 patients), and 6-12 months (16 patients). RESULTS Estimated mean annualized relapse rates (ARR) over a mean treatment period of 44 months were 0.26 for NTZ and 0.32 for FTY (p = 0.381) over 46 months. In the treatment gap, differences were found concerning the relapse probability, seven (5.2%) patients in the < 3 months group, six (13.6%) in thef 3-6 months group, and seven (43.8%) in the 6-12 months group (p < 0.001). After this treatment gap, no significant differences concerning ARR, EDSS change, EDSS progression, and regression were observed regardless the proceeding transition periods. Significantly higher efficacy of NTZ compared to FTY in sequential use was found regarding EDSS change, EDSS progression, and EDSS regression sustained for 12 and 24 weeks. CONCLUSIONS First, we here show an increased short-time risk for relapses during the treatment gap between NTZ and FTY therapy, dependent on the length of transition time. Second, the disease course after switching to FTY remained stable in the long-term evaluation. Therefore, switching from NTZ to FTY in a real-world setting appears efficacious and safe, but this data advocate for a short switching gap of 3 months or less.
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Affiliation(s)
- Michael Guger
- Clinic for Neurology 2, Med Campus III, Kepler University Clinic, Krankenhausstrasse 9, 4021, Linz, Austria.
| | | | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jörg Kraus
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria.,Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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7
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Prosperini L, Kinkel RP, Miravalle AA, Iaffaldano P, Fantaccini S. Post-natalizumab disease reactivation in multiple sclerosis: systematic review and meta-analysis. Ther Adv Neurol Disord 2019. [PMID: 30956686 DOI: 10.1177/1756286419837809.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Natalizumab (NTZ) is sometimes discontinued in patients with multiple sclerosis, mainly due to concerns about the risk of progressive multifocal leukoencephalopathy. However, NTZ interruption may result in recrudescence of disease activity. Objective The objective of this study was to summarize the available evidence about NTZ discontinuation and to identify which patients will experience post-NTZ disease reactivation through meta-analysis of existing literature data. Methods PubMed was searched for articles reporting the effects of NTZ withdrawal in adult patients (⩾18 years) with relapsing-remitting multiple sclerosis (RRMS). Definition of disease activity following NTZ discontinuation, proportion of patients who experienced post-NTZ disease reactivation, and timing to NTZ discontinuation to disease reactivation were systematically reviewed. A generic inverse variance with random effect was used to calculate the weighted effect of patients' clinical characteristics on the risk of post-NTZ disease reactivation, defined as the occurrence of at least one relapse. Results The original search identified 205 publications. Thirty-five articles were included in the systematic review. We found a high level of heterogeneity across studies in terms of sample size (10 to 1866 patients), baseline patient characteristics, follow up (1-24 months), outcome measures (clinical and/or radiological), and definition of post-NTZ disease reactivation or rebound. Clinical relapses were observed in 9-80% of patients and peaked at 4-7 months, whereas radiological disease activity was observed in 7-87% of patients starting at 6 weeks following NTZ discontinuation. The meta-analysis of six articles, yielding a total of 1183 patients, revealed that younger age, higher number of relapses and gadolinium-enhanced lesions before treatment start, and fewer NTZ infusions were associated with increased risk for post-NTZ disease reactivation (p ⩽ 0.05). Conclusions Results from the present review and meta-analysis can help to profile patients who are at greater risk of post-NTZ disease reactivation. However, potential reporting bias and variability in selected studies should be taken into account when interpreting our data.
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Affiliation(s)
- Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
| | - Revere P Kinkel
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Augusto A Miravalle
- Advanced Neurology of Colorado, MS Center of the Rockies, University of Colorado Denver, Aurora, CO, USA
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
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8
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Prosperini L, Kinkel RP, Miravalle AA, Iaffaldano P, Fantaccini S. Post-natalizumab disease reactivation in multiple sclerosis: systematic review and meta-analysis. Ther Adv Neurol Disord 2019; 12:1756286419837809. [PMID: 30956686 PMCID: PMC6444403 DOI: 10.1177/1756286419837809] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/04/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Natalizumab (NTZ) is sometimes discontinued in patients with multiple
sclerosis, mainly due to concerns about the risk of progressive multifocal
leukoencephalopathy. However, NTZ interruption may result in recrudescence
of disease activity. Objective: The objective of this study was to summarize the available evidence about NTZ
discontinuation and to identify which patients will experience post-NTZ
disease reactivation through meta-analysis of existing literature data. Methods: PubMed was searched for articles reporting the effects of NTZ withdrawal in
adult patients (⩾18 years) with relapsing–remitting multiple sclerosis
(RRMS). Definition of disease activity following NTZ discontinuation,
proportion of patients who experienced post-NTZ disease reactivation, and
timing to NTZ discontinuation to disease reactivation were systematically
reviewed. A generic inverse variance with random effect was used to
calculate the weighted effect of patients’ clinical characteristics on the
risk of post-NTZ disease reactivation, defined as the occurrence of at least
one relapse. Results: The original search identified 205 publications. Thirty-five articles were
included in the systematic review. We found a high level of heterogeneity
across studies in terms of sample size (10 to 1866 patients), baseline
patient characteristics, follow up (1–24 months), outcome measures (clinical
and/or radiological), and definition of post-NTZ disease reactivation or
rebound. Clinical relapses were observed in 9–80% of patients and peaked at
4–7 months, whereas radiological disease activity was observed in 7–87% of
patients starting at 6 weeks following NTZ discontinuation. The
meta-analysis of six articles, yielding a total of 1183 patients, revealed
that younger age, higher number of relapses and gadolinium-enhanced lesions
before treatment start, and fewer NTZ infusions were associated with
increased risk for post-NTZ disease reactivation (p ⩽
0.05). Conclusions: Results from the present review and meta-analysis can help to profile
patients who are at greater risk of post-NTZ disease reactivation. However,
potential reporting bias and variability in selected studies should be taken
into account when interpreting our data.
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Affiliation(s)
- Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
| | - Revere P Kinkel
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Augusto A Miravalle
- Advanced Neurology of Colorado, MS Center of the Rockies, University of Colorado Denver, Aurora, CO, USA
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
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Desai RJ, Mahesri M, Gagne JJ, Hurley E, Tong A, Chitnis T, Minden S, Spettell CM, Matlin OS, Shrank WH, Choudhry NK. Utilization Patterns of Oral Disease-Modifying Drugs in Commercially Insured Patients with Multiple Sclerosis. J Manag Care Spec Pharm 2019; 25:113-121. [PMID: 30589630 PMCID: PMC10397781 DOI: 10.18553/jmcp.2019.25.1.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The approval of new oral disease-modifying drugs (DMDs), such as fingolimod, dimethyl fumarate (DMF), and teriflunamide, has considerably expanded treatment options for relapsing forms of multiple sclerosis (MS). However, data describing the use of these agents in routine clinical practice are limited. OBJECTIVE To describe time trends and identify factors associated with oral DMD treatment initiation and switching among individuals with MS. METHODS Using data from a large sample of commercially insured patients, we evaluated changes over time in the proportion of MS patients who initiated treatment with an oral DMD and who switched from an injectable DMD to an oral DMD between 2009 and 2014 in the United States. We evaluated predictors of oral DMD use using conditional logistic regression in 2 groups matched on calendar time: oral DMD initiators matched to injectable DMDs initiators and oral DMD switchers matched to those who switched to a second injectable DMD. RESULTS Our cohort included 7,576 individuals who initiated a DMD and 1,342 who switched DMDs, of which oral DMDs accounted for 6% and 39%, respectively. Oral DMD initiation and switching steadily increased from 5% to 16% and 35% to 84%, respectively, between 2011 and 2014, with DMF being the most commonly used agent. Of the potential predictors with clinical significance, a recent neurologist consultation (OR = 1.60; 95% CI = 1.20-2.15) and emergency department visit (OR = 1.43; 95% CI = 1.01-2.01) were significantly associated with oral DMD initiation. History of depression was noted to be a potential predictor of oral DMD initiation; however, the estimate for this predictor did not reach statistical significance (OR = 1.35; 95% CI = 0.99-1.84). No clinically relevant factors measured in our data were associated with switching to an oral DMD. CONCLUSIONS Oral DMDs were found to be routinely used as second-line treatment. However, we identified few factors predictive of oral DMD initiation or switching, which implies that their selection is driven by patient and/or physician preferences. DISCLOSURES This study was funded by CVS Caremark through an unrestricted research grant to Brigham and Women's Hospital. Shrank and Matlin were employees of, and shareholders in, CVS Health at the time of the study; they report no financial interests in products or services that are related to the subject of this study. Spettell is an employee of, and shareholder in, Aetna. Chitnis serves on clinical trial advisory boards for Novartis and Genzyme-Sanofi; has consulted for Bayer, Biogen Idec, Celgene, Novartis, Merck-Serono, and Genentech-Roche; and has received research support from NIH, National Multiple Sclerosis Society, Peabody Foundation, Consortium for MS Centers, Guthy Jackson Charitable Foundation, EMD-Serono, Novartis Biogen, and Verily. Desai reports receiving a research grant from Merck for unrelated work. Gagne is principal investigator of a research grant from Novartis Pharmaceuticals Corporation to the Brigham and Women's Hospital and has received grant support from Eli Lilly, all for unrelated work. He is also a consultant to Aetion and Optum. Minden reports grants from Biogen and other fees from Genentech, EMD Serano, Avanir, and Novartis, unrelated to this study. The other authors have no conflicts to report. This study was presented as a poster at the International Society for Pharmacoepidemiology 32nd Annual Meeting; August 25-28, 2016; Dublin, Ireland.
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Affiliation(s)
- Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Joshua J. Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Eimir Hurley
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
| | - Angela Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Tanuja Chitnis
- Department of Neurology Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | - Sarah Minden
- Department of Psychiatry, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Niteesh K. Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts
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Diem L, Nedeltchev K, Kahles T, Achtnichts L, Findling O. Long-term evaluation of NEDA-3 status in relapsing-remitting multiple sclerosis patients after switching from natalizumab to fingolimod. Ther Adv Neurol Disord 2018; 11:1756286418791103. [PMID: 30116299 PMCID: PMC6088480 DOI: 10.1177/1756286418791103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Natalizumab significantly reduces the disease activity in patients with relapsing-remitting multiple sclerosis but due to the risk of progressive multifocal leukoencephalopathy it is often discontinued. Fingolimod is seen as an alternative, but there are no long-term analyses of the efficacy of fingolimod in this setting using the no evidence of disease activity (NEDA)-3 criteria. We provide an assessment of patients who discontinued natalizumab and switched to fingolimod or other treatments by evaluating the proportion of patients who fulfil NEDA-3 criteria after prolonged follow-up periods. Methods: We conducted a retrospective observational study of multiple sclerosis patients, who were treated with continuous natalizumab or who had switched to fingolimod or other treatments after natalizumab discontinuation. We assessed NEDA-3 status, annual relapse rate and determined the odds ratio between disease course after treatment switch and other patient and treatment characteristics. Results: A total of 61 patients on continuous natalizumab treatment and 53 patients who switched from natalizumab to fingolimod or other treatments were accompanied for up to 5 years. While the proportion of natalizumab patients fulfilling NEDA-3 criteria remained stable at 90% during the entire follow-up period, the proportion of patients switching to fingolimod or other therapies dropped to 76.7% in the first year after discontinuation, and to 50% in the years thereafter. While the median Expanded Disability Status Scale remained stable and the percentage of relapsing patients did not change significantly, recurring magnetic resonance imaging activity was found in up to 42% of the patients after switching from natalizumab to other treatments. New disease activity was significantly correlated with extended treatment gap between natalizumab discontinuation and the start of a new therapy. Discussion: Patients remain clinically stable after discontinuing natalizumab and switching to other therapies. However, when considering NEDA-3 criteria, a considerable proportion of patients show disease reactivation. Careful monitoring and early evaluation of alternatives is necessary after switching from natalizumab to other treatments.
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Affiliation(s)
- Lara Diem
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | | | - Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Oliver Findling
- Department of Neurology, Cantonal Hospital Aarau, Tellstrasse, Aarau 5000, Switzerland
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11
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Giuliani M, Logoteta A, Prosperini L, Hirsch MN, Pozzilli C. Baseline characteristics associated with NEDA-3 status in fingolimod-treated patients with relapsing-remitting multiple sclerosis. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40893-017-0026-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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12
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Demır GA, Türkoğlu R, Saıp S, Yüceyar N, Efendı H, Turan ÖF, Ağan K, Terzı M, Boz C, Tuncer A, Koçer B, Kasap M, Çalişkan Z. A 12-month, Open Label, Multicenter Pilot Study Evaluating Fingolimod Treatment in terms of Patient Satisfaction in Relapsing Remitting Multiple Sclerosis Patients - FINE Trial. Noro Psikiyatr Ars 2017; 56:253-257. [PMID: 31903032 DOI: 10.5152/npa.2017.20515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/11/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction To assess satisfaction and quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) who were receiving fingolimod (0.5 mg/day) for 12 months as a second-line treatment after switching from injectable agents. Methods Patients aged 18-65 years with RRMS who fulfilled the eligibility criteria were enrolled from 16 centers throughout Turkey. Treatment Satisfaction Questionnaire for Medication and 36-item Short-Form Health Survey were completed at baseline and four visits to assess patient satisfaction and quality of life. Results Forty-two patients (62% male; mean age: 35.7±9.4 years) were eligible for inclusion. Patient satisfaction scores at the end of the study (44.7±9.9) were significantly higher than those at baseline [32.0±9.9; (p<0.001)]. The only significant increase in the quality of life survey was in the emotional aspect (p=0.019). There were 124 adverse events and none of the five serious adverse events noted was considered drug-related. Conclusion Large-scale comparative studies performed with disease specific quality of life instruments will allow more information on this issue.
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Affiliation(s)
- Gülşen Akman Demır
- Department of Neurology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Recai Türkoğlu
- Department of Neurology, Haydarpaşa Numune Training Research Hospital, İstanbul, Turkey
| | - Sabahattin Saıp
- Department of Neurology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Nur Yüceyar
- Department of Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Hüsnü Efendı
- Department of Neurology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Uludağ University School of Medicine, Bursa, Turkey
| | - Kadriye Ağan
- Department of Neurology, Marmara University School of Medicine İstanbul, Turkey
| | - Murat Terzı
- Department of Neurology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Cavit Boz
- Department of Neurology, Karadeniz Teknik University School of Medicine, Trabzon, Turkey
| | - Aslı Tuncer
- Department of Neurology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Belgin Koçer
- Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Mithat Kasap
- Department of Medical, Novartis Pharmaceuticals Turkey, İstanbul, Turkey
| | - Zeynep Çalişkan
- Department of Medical, Novartis Pharmaceuticals Turkey, İstanbul, Turkey
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13
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Roux T, Maillart E, Vidal JS, Tezenas du Montcel S, Lubetzki C, Papeix C. Efficacy and Safety of Fingolimod in Daily Practice: Experience of an Academic MS French Center. Front Neurol 2017; 8:183. [PMID: 28529497 PMCID: PMC5418224 DOI: 10.3389/fneur.2017.00183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Fingolimod (Fg), a sphingosine 1-phosphate receptor modulator, decreases the annual relapse rate (ARR) in relapsing-remitting multiple sclerosis (RRMS). The aim of this study was to assess the efficacy and safety of Fg in daily practice in patients with RRMS, previously treated with natalizumab (Nz) or not, and systematically followed during at least 1 year. Methods Data were collected from the patient files. Primary endpoint was the comparison between the ARR the year before Fg onset and after 1 and 2 years of Fg treatment. The secondary endpoints were the difference between Expanded Disability Status Scale (EDSS) at Fg onset and after 1 and 2 years of treatment, and safety. Results In the whole sample, we confirmed Fg efficacy on the ARR (0.895 before vs. 0.364 1 year after, p < 0.0001). Between our two groups (with or without Nz before Fg), the ARR was higher in the Nz group during the first year but similar during the second year. The EDSS was stable during the first year of Fg but significantly higher after 2 years (3.33 vs. 3.72, p = 0.02). Concerning safety, only three patients had to discontinue Fg because of tolerance issues. Conclusion Our study showed that Fg is safe in RRMS and can be used either after first-line treatments or after Nz. However we observed a mild disability progression after 2 years.
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Affiliation(s)
- Thomas Roux
- AP-HP, Neurology Department, Pitié-Salpétrière Hospital, Paris, France
| | | | | | | | | | - Caroline Papeix
- AP-HP, Neurology Department, Pitié-Salpétrière Hospital, Paris, France
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14
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Comi G, Radaelli M, Soelberg Sørensen P. Evolving concepts in the treatment of relapsing multiple sclerosis. Lancet 2017; 389:1347-1356. [PMID: 27889192 DOI: 10.1016/s0140-6736(16)32388-1] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 11/16/2022]
Abstract
In the past 20 years the treatment scenario of multiple sclerosis has radically changed. The increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses and disability accrual, to the absence of any sign of clinical or MRI activity. The choice for therapy is increasingly complex and should be driven by an appropriate knowledge of the mechanisms of action of the different drugs and of their risk-benefit profile. Because the relapsing phase of the disease is characterised by inflammation, treatment should be started as early as possible and aim to re-establish the normal complex interactions in the immune system. Before starting a treatment, neurologists should carefully consider the state of the disease, its prognostic factors and comorbidities, the patient's response to previous treatments, and whether the patient is likely to accept treatment-related risks in order to maximise benefits and minimise risks. Early detection of suboptimum responders, thanks to accurate clinical monitoring, will allow clinicians to redesign treatment strategies where necessary.
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Affiliation(s)
- Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy.
| | - Marta Radaelli
- Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy
| | - Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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15
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Costa BKD, Sato DK. Sometimes less is more in multiple sclerosis drug switching. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:605-606. [PMID: 27556369 DOI: 10.1590/0004-282x20160104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Bruna Klein da Costa
- Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas e Instituto do Cérebro, Serviço de Neurologia, Porto Alegre RS, Brasil
| | - Douglas Kazutoshi Sato
- Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas e Instituto do Cérebro, Serviço de Neurologia, Porto Alegre RS, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brasil
- Tohoku University Graduate School of Medicine, Department of Neurology, Sendai, Japan
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16
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Fragoso YD, Adoni T, Alves-Leon SV, Apostolos-Pereira SL, Araujo YRD, Becker J, Brooks JBB, Correa EC, Damasceno A, Damasceno CADA, Ferreira MLB, Gama PDD, Gama RADD, Gomes S, Goncalves MVM, Grzesiuk AK, Machado SCN, Matta APDC, Mendes MF, Ribeiro TAGJ, Rocha CFD, Ruocco HH, Sato H, Simm RF, Tauil CB, Vasconcelos CCF, Vieira VLF. Alternatives for reducing relapse rate when switching from natalizumab to fingolimod in multiple sclerosis. Expert Rev Clin Pharmacol 2016; 9:541-546. [DOI: 10.1586/17512433.2016.1145053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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17
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Kappos L, Radue EW, Chin P, Ritter S, Tomic D, Lublin F. Onset of clinical and MRI efficacy occurs early after fingolimod treatment initiation in relapsing multiple sclerosis. J Neurol 2016; 263:354-360. [PMID: 26645392 PMCID: PMC4751181 DOI: 10.1007/s00415-015-7978-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 10/25/2022]
Abstract
To minimize the clinical burden associated with multiple sclerosis (MS), early control of focal and diffuse CNS disease activity is a treatment priority. A post hoc analysis was conducted to evaluate the onset of efficacy of fingolimod treatment in patients with relapsing MS. Data from patients who received fingolimod 0.5 mg or placebo during either of two 24-month, double-blind, randomized, parallel-group clinical trials (FREEDOMS and FREEDOMS II) were pooled for analysis. Efficacy outcomes were: time to first confirmed relapse; annualized relapse rate (ARR); proportions of patients free from T1 gadolinium-enhancing lesions or new/newly enlarged T2 lesions; percentage brain volume loss (BVL); and change in Multiple Sclerosis Functional Composite (MSFC) z-score from baseline to 6 months. An early benefit was seen with fingolimod (N = 783) vs. placebo (N = 773) for ARR at both 3 and 6 months (3 months, 0.32 vs. 0.52, p = 0.0015; 6 months, 0.21 vs. 0.45, p < 0.0001). Time to first relapse was also delayed with fingolimod vs. placebo from day 48 onwards. At 6 months, more patients in the fingolimod group than in the placebo group were free from new MRI activity (65.3 vs. 40.5%, p < 0.0001) and had less BVL (37.1% reduction vs. placebo, p < 0.001). MSFC z-score favored fingolimod over placebo at 6 months, with improvements noted in 9-Hole Peg Test and Paced Auditory Serial Addition Test scores. Improvements in outcomes related to relapses, MRI, disability, cognition, and BVL occurred within 6 months of treatment initiation with fingolimod.
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Affiliation(s)
- Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital, Petersgraben 4, 4031, Basel, Switzerland.
| | - Ernst-Wilhelm Radue
- Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
| | - Peter Chin
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Shannon Ritter
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Fred Lublin
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Spelman T, Mekhael L, Burke T, Butzkueven H, Hodgkinson S, Havrdova E, Horakova D, Duquette P, Izquierdo G, Grand'Maison F, Grammond P, Barnett M, Lechner-Scott J, Alroughani R, Trojano M, Lugaresi A, Granella F, Pucci E, Vucic S. Risk of early relapse following the switch from injectables to oral agents for multiple sclerosis. Eur J Neurol 2016; 23:729-36. [DOI: 10.1111/ene.12929] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
Affiliation(s)
- T. Spelman
- Department of Neurology; Royal Melbourne Hospital; Parkville Vic. Australia
- Department of Medicine (RMH); University of Melbourne; Parkville Vic. Australia
| | | | - T. Burke
- Westmead Hospital; Sydney NSW Australia
| | - H. Butzkueven
- Department of Neurology; Royal Melbourne Hospital; Parkville Vic. Australia
- Department of Medicine (RMH); University of Melbourne; Parkville Vic. Australia
| | | | | | | | | | - G. Izquierdo
- Hospital Universitario Virgen Macarena; Sevilla Spain
| | | | - P. Grammond
- Center de réadaptation déficience physique Chaudière-Appalache; Levis QC Canada
| | - M. Barnett
- Brain and Mind Research Institute; Sydney NSW Australia
| | | | | | - M. Trojano
- Department of Basic Medical Sciences; Neuroscience and Sense Organs; University of Bari; Bari Italy
| | - A. Lugaresi
- MS Center; Department of Neuroscience, Imaging and Clinical Sciences; University ‘G. d'Annunzio’; Chieti Italy
| | - F. Granella
- Department of Neurosciences; University of Parma; Parma Italy
| | - E. Pucci
- Neurology Unit; ASUR Marche - AV3; Macerata Italy
| | - S. Vucic
- Westmead Hospital; Sydney NSW Australia
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19
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Gajofatto A, Turatti M, Monaco S, Benedetti MD. Clinical efficacy, safety, and tolerability of fingolimod for the treatment of relapsing-remitting multiple sclerosis. DRUG HEALTHCARE AND PATIENT SAFETY 2015; 7:157-67. [PMID: 26715860 PMCID: PMC4686225 DOI: 10.2147/dhps.s69640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fingolimod is a selective immunosuppressive agent approved worldwide for the treatment of relapsing-remitting multiple sclerosis (MS), a chronic and potentially disabling neurological condition. Randomized double-blind clinical trials have shown that fingolimod significantly reduces relapse rate and ameliorates a number of brain MRI measures, including cerebral atrophy, compared to both placebo and intramuscular interferon-β1a. The effect on disability progression remains controversial, since one Phase III trial showed a significant benefit of treatment while two others did not. Although fingolimod has a very convenient daily oral dosing, the possibility of serious cardiac, ocular, infectious, and other rare adverse events justified the decision of the European Medicines Agency to approve the drug as a second-line treatment for MS patients not responsive to first-line therapy, or those with rapidly evolving course. In the United States, fingolimod is instead authorized as a first-line treatment. The aim of this review is to describe and discuss the characteristics of fingolimod concerning its efficacy, safety, and tolerability in the clinical context of multiple sclerosis management.
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Affiliation(s)
- Alberto Gajofatto
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy ; Division of Neurology B, Verona University Hospital, Verona, Italy
| | - Marco Turatti
- Division of Neurology B, Verona University Hospital, Verona, Italy
| | - Salvatore Monaco
- Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy ; Division of Neurology B, Verona University Hospital, Verona, Italy
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20
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Iaffaldano P, Lucisano G, Pozzilli C, Brescia Morra V, Ghezzi A, Millefiorini E, Patti F, Lugaresi A, Zimatore GB, Marrosu MG, Amato MP, Bertolotto A, Bergamaschi R, Granella F, Coniglio G, Tedeschi G, Sola P, Lus G, Ferrò MT, Iuliano G, Corea F, Protti A, Cavalla P, Guareschi A, Rodegher M, Paolicelli D, Tortorella C, Lepore V, Prosperini L, Saccà F, Baroncini D, Comi G, Trojano M. Fingolimod versus interferon beta/glatiramer acetate after natalizumab suspension in multiple sclerosis. Brain 2015; 138:3275-86. [PMID: 26362907 DOI: 10.1093/brain/awv260] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/09/2015] [Indexed: 02/04/2023] Open
Abstract
The comparative effectiveness of fingolimod versus interferon beta/glatiramer acetate was assessed in a multicentre, observational, prospectively acquired cohort study including 613 patients with relapsing multiple sclerosis discontinuing natalizumab in the Italian iMedWeb registry. First, after natalizumab suspension, the relapse risk during the untreated wash-out period and during the course of switch therapies was estimated through Poisson regression analyses in separated models. During the wash-out period an increased risk of relapses was found in patients with a higher number of relapses before natalizumab treatment (incidence rate ratio = 1.31, P = 0.0014) and in patients discontinuing natalizumab due to lack of efficacy (incidence rate ratio = 2.33, P = 0.0288), patient's choice (incidence rate ratio = 2.18, P = 0.0064) and adverse events (incidence rate ratio = 2.09, P = 0.0084). The strongest independent factors influencing the relapse risk after the start of switch therapies were a wash-out duration longer than 3 months (incidence rate ratio = 1.78, P < 0.0001), the number of relapses experienced during and before natalizumab treatment (incidence rate ratio = 1.61, P < 0.0001; incidence rate ratio = 1.13, P = 0.0118, respectively) and the presence of comorbidities (incidence rate ratio = 1.4, P = 0.0097). Switching to fingolimod was associated with a 64% reduction of the adjusted-risk for relapse in comparison with switching to interferon beta/glatiramer acetate (incidence rate ratio = 0.36, P < 0.0001). Secondly, patients who switched to fingolimod or to interferon beta/glatiramer acetate were propensity score-matched on a 1-to-1 basis at the switching date. In the propensity score-matched sample a Poisson model showed a significant lower incidence of relapses in patients treated with fingolimod in comparison with those treated with interferon beta/glatiramer acetate (incidence rate ratio = 0.52, P = 0.0003) during a 12-month follow-up. The cumulative probability of a first relapse after the treatment switch was significantly lower in patients receiving fingolimod than in those receiving interferon beta/glatiramer acetate (P = 0.028). The robustness of this result was also confirmed by sensitivity analyses in subgroups with different wash-out durations (less or more than 3 months). Time to 3-month confirmed disability progression was not significantly different between the two groups (Hazard ratio = 0.58; P = 0.1931). Our results indicate a superiority of fingolimod in comparison to interferon beta/glatiramer acetate in controlling disease reactivation after natalizumab discontinuation in the real life setting.
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Affiliation(s)
- Pietro Iaffaldano
- 1 Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giuseppe Lucisano
- 1 Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy 2 Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Foundation, Via Nazionale per Lanciano 8, 66030, Santa Maria Imbaro (CH), Italy
| | - Carlo Pozzilli
- 3 Multiple Sclerosis Center, S.Andrea Hospital, Dept. of Neurology and Psychiatry, La Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - Vincenzo Brescia Morra
- 4 Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini 5, 80131 Napoli, Italy
| | - Angelo Ghezzi
- 5 Multiple Sclerosis Center, S.Antonio Abate Hospital, Via Pastori 4, 21013 Gallarate (VA), Italy
| | - Enrico Millefiorini
- 6 Multiple Sclerosis Center, Policlinico Umberto I, La Sapienza University, Viale dell'Università 30, 00185, Rome, Italy
| | - Francesco Patti
- 7 Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Alessandra Lugaresi
- 8 Department of Neuroscience, Imaging and Clinical Sciences, Multiple Sclerosis Center, "SS. Annunziata" Hospital, University "G. D'Annunzio", Via dei Vestini snc, 66100, Chieti, Italy
| | - Giovanni Bosco Zimatore
- 9 Operative Unit of Neurology, "Dimiccoli" General Hospital, Viale Ippocrate 15, 76121, Barletta, Italy
| | - Maria Giovanna Marrosu
- 10 Multiple Sclerosis Center, University of Cagliari, Via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Maria Pia Amato
- 11 Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Antonio Bertolotto
- 12 Neurologia 2, CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU S. Luigi, Regione Gonzole 10, 10043 Orbassano (TO), Italy
| | - Roberto Bergamaschi
- 13 Inter-department Multiple Sclerosis Research Centre, C. Mondino National Institute of Neurology Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Franco Granella
- 14 Department of Neurosciences, University of Parma, Via Volturno 39, 43125, Parma, Italy
| | - Gabriella Coniglio
- 15 Neurology Unit, "Madonna delle Grazie" Hospital, Contrada Cattedra Ambulante snc, 75100, Matera, Italy
| | - Gioacchino Tedeschi
- 16 Division of Neurology, Second University of Naples, Via Costantinopoli 104, 80138, Naples, Italy
| | - Patrizia Sola
- 17 Department of Neurosciences, Neurology Unit, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino/Estense, Via Giardini 1355, 41126, Modena, Italy
| | - Giacomo Lus
- 18 Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Via Luciano Armanni 5, 80138, Napoli, Italy
| | - Maria Teresa Ferrò
- 19 Neurological Department, "Maggiore" Hospital, Largo Dossena 2, 26013, Crema, Italy
| | - Gerardo Iuliano
- 20 Department of Neurosciences, "S.Giovanni di Dio" Hospital, Largo Città di Ippocrate, 84131, Salerno, Italy
| | - Francesco Corea
- 21 Neurology Unit, "S.Giovanni Battista" Hospital, Via Arcamone, 06124, Foligno, Italy
| | - Alessandra Protti
- 22 Multiple Sclerosis Center, Neurological Department, "Niguarda Ca' Granda" Hospital, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Paola Cavalla
- 23 Multiple Sclerosis Center, Department of Neuroscience, University of Turin & City of Health and Science University Hospital of Turin, Via Verdi 8, 10124, Turin, Italy
| | - Angelica Guareschi
- 24 Multiple Sclerosis Center, Medicine Department, Fidenza Hospital, Via Don Enrico Tincati 5, 43125 Fidenza, Italy
| | - Mariaemma Rodegher
- 25 Department of Neurology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Via Olgettina, 48 20132, Milan, Italy
| | - Damiano Paolicelli
- 1 Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Carla Tortorella
- 1 Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Vito Lepore
- 2 Department of Clinical Pharmacology and Epidemiology, Mario Negri Sud Foundation, Via Nazionale per Lanciano 8, 66030, Santa Maria Imbaro (CH), Italy
| | - Luca Prosperini
- 3 Multiple Sclerosis Center, S.Andrea Hospital, Dept. of Neurology and Psychiatry, La Sapienza University, Via di Grottarossa, 1035, 00189, Rome, Italy
| | - Francesco Saccà
- 4 Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Via Pansini 5, 80131 Napoli, Italy
| | - Damiano Baroncini
- 5 Multiple Sclerosis Center, S.Antonio Abate Hospital, Via Pastori 4, 21013 Gallarate (VA), Italy
| | - Giancarlo Comi
- 25 Department of Neurology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Via Olgettina, 48 20132, Milan, Italy
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Tanaka M. [Natalizumab treatment in multiple sclerosis]. Rinsho Shinkeigaku 2015; 55:537-43. [PMID: 26156254 DOI: 10.5692/clinicalneurol.cn-000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multiple sclerosis is a neurodegenerative and inflammatory immune disorder in the central nervous system (CNS). Most patients show relapse-remitting clinical course. Some disease modifying medications for preventing the relapses including natalizumab (NTZ) are approved in Japan. Natalizumab (NTZ), a monoclonal antibody against α4 integrin present on the surface of lymphocytes, inhibits the binding of lymphocytes to vascular cell adhesion molecule-1 (VCAM-1) of endothelial cells and blocks the penetration of encephalitogenic T cells into the CNS. This review provides an update on the efficacy of an inhibition of relapses, adverse effects including progressive multifocal leukoencephalopathy, treatment after NTZ discontinuation, and body weight based treatment.
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Affiliation(s)
- Masami Tanaka
- Multiple Sclerosis Center, National Hospital Organization, Utano National Hospital
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22
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Kappos L, Radue EW, Comi G, Montalban X, Butzkueven H, Wiendl H, Giovannoni G, Hartung HP, Derfuss T, Naegelin Y, Sprenger T, Mueller-Lenke N, Griffiths S, von Rosenstiel P, Gottschalk R, Zhang Y, Dahlke F, Tomic D. Switching from natalizumab to fingolimod: A randomized, placebo-controlled study in RRMS. Neurology 2015; 85:29-39. [PMID: 26024899 PMCID: PMC4501941 DOI: 10.1212/wnl.0000000000001706] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/21/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of different natalizumab washout (WO) periods on recurrence of MRI and clinical disease activity in patients switching from natalizumab to fingolimod. METHODS In this multicenter, double-blind, placebo-controlled trial (TOFINGO), patients with relapsing-remitting multiple sclerosis (RRMS) were randomized 1:1:1 to 8-, 12-, or 16-week WO followed by fingolimod treatment over 32 weeks from last natalizumab infusion (LNI). Brain MRI was performed at baseline and weeks 8, 12, 16, 20, and 24. RESULTS Of 142 enrolled and randomized patients, 112 (78.9%) completed the study (8 weeks, n = 41/50; 12 weeks, n = 31/42; 16 weeks, n = 40/50). Number (95% confidence interval [CI]) of active (new/newly enlarged T2) lesions from LNI through 8 weeks of fingolimod treatment (primary outcome) was similar in the 8-week (2.1 [1.7-2.6]) and 12-week WO groups (1.7 [1.3-2.2]) and higher in the 16-week WO group (8.2 [7.3-9.1]). During the WO period only, the number (95% CI) of active lesions increased with increasing WO duration (8 weeks, 0.4 [0.2-0.6]; 12 weeks, 2.1 [1.6-2.6]; 16 weeks, 3.6 [3.0-4.2]). Over the 24 weeks from LNI, gadolinium-enhancing T1 lesion counts were lower in the 8-week WO group (14.1 [5.67-22.53]) than in the 12-week (21.3 [1.41-41.19]) or 16-week (18.5 [8.40-28.60]) WO groups. More patients were relapse-free in the 8-week (88%) and 12-week (91%) WO groups than the 16-week WO group (84%). Sixty-eight percent of patients experienced adverse events (mostly mild/moderate), with similar incidence across groups. No unusually severe relapses or opportunistic infections occurred. CONCLUSIONS Initiating fingolimod therapy 8-12 weeks after natalizumab discontinuation is associated with a lower risk of MRI and clinical disease reactivation than initiation after 16-week WO. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with RRMS switching from natalizumab to fingolimod, shorter natalizumab WO periods are associated with less MRI disease activity than are longer WO periods.
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Affiliation(s)
- Ludwig Kappos
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ.
| | - Ernst-Wilhelm Radue
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Giancarlo Comi
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Xavier Montalban
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Helmut Butzkueven
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Heinz Wiendl
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Gavin Giovannoni
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Hans-Peter Hartung
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Tobias Derfuss
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Yvonne Naegelin
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Till Sprenger
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Nicole Mueller-Lenke
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Sarah Griffiths
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Philipp von Rosenstiel
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Rebecca Gottschalk
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Ying Zhang
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Frank Dahlke
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Davorka Tomic
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
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23
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Abstract
Sphingosine 1-phosphate (S1P) receptor modulators possess a unique mechanism of action as disease-modifying therapy for multiple sclerosis (MS). Subtype 1 S1P receptors are expressed on the surfaces of lymphocytes and are important in regulating egression from lymph nodes. The S1P receptor modulators indirectly antagonize the receptor's function and sequester lymphocytes in lymph nodes. Fingolimod was the first S1P agent approved in the USA in 2010 for relapsing MS after two phase III trials (FREEDOMS and TRANSFORMS) demonstrated potent efficacy, and good safety and tolerability. Post-marketing experience, as well as a third phase III trial (FREEDOMS II), also showed favorable results. More selective S1P receptor agents-ponesimod (ACT128800), siponimod (BAF312), ozanimod (RPC1063), ceralifimod (ONO-4641), GSK2018682, and MT-1303-are still in relatively early stages of development, but phase I and II trials showed promising efficacy and safety. However, these observations have yet to be reproduced in phase III clinical trials.
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Affiliation(s)
- Adnan M. Subei
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH 44195, Phone: 216-445-8110, Fax: 216-445-7013
| | - Jeffrey A. Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH 44195, Phone: 216-445-8110, Fax: 216-445-7013
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Correale J, Flores J, Bonitto JG, Rodríguez CC, Oliveira EML. Use of Fingolimod in the Management of Relapsing-Remitting Multiple Sclerosis: Experience from Latin America. Adv Ther 2015; 32:612-25. [PMID: 26170106 PMCID: PMC4522024 DOI: 10.1007/s12325-015-0226-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED Once-daily fingolimod 0.5 mg (FTY720; Gilenya(®), Novartis Pharma AG, Basel, Switzerland) is a sphingosine 1-phosphate receptor modulator that is approved for the treatment of relapsing multiple sclerosis (MS); currently, this includes approval in 13 Latin American countries. However, despite a well-characterized efficacy and safety profile in a large clinical development program, thus far there has been limited representation of patients from across the Latin American region. Differences in MS disease characteristics have been reported for the Latin American population compared with Caucasians, which may be additional to recent improvements in MS diagnosis. Furthermore, healthcare provision and regional socioeconomic factors exist that are unique to Latin America compared with other regions. Therefore, to optimize MS treatment pathways and improve patient clinical outcomes, it is important to investigate the efficacy and safety profile of fingolimod using ethnically relevant data. Here, we review key data from Hispanic patients enrolled in the fingolimod clinical trial program, summarize recent findings from the FIRST LATAM study, and appraise fingolimod data from real-world patient populations. FUNDING Novartis Pharma AG, Basel, Switzerland.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Institute for Neurological Research Raúl Carrea, FLENI, Buenos Aires, Argentina,
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D’Amico E, Leone C, Caserta C, Patti F. Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal. Expert Rev Neurother 2015; 15:803-24. [DOI: 10.1586/14737175.2015.1058162] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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