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Sharmin S, Lefort M, Andersen JB, Leray E, Horakova D, Havrdova EK, Alroughani R, Izquierdo G, Ozakbas S, Patti F, Onofrj M, Lugaresi A, Terzi M, Grammond P, Grand'Maison F, Yamout B, Prat A, Girard M, Duquette P, Boz C, Trojano M, McCombe P, Slee M, Lechner-Scott J, Turkoglu R, Sola P, Ferraro D, Granella F, Prevost J, Maimone D, Skibina O, Buzzard K, Van der Walt A, Van Wijmeersch B, Csepany T, Spitaleri D, Vucic S, Casey R, Debouverie M, Edan G, Ciron J, Ruet A, De Sèze J, Maillart E, Zephir H, Labauge P, Defer G, Lebrun-Frénay C, Moreau T, Berger E, Clavelou P, Pelletier J, Stankoff B, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Wahab A, Camdessanché JP, Maurousset A, Patry I, Hankiewicz K, Pottier C, Maubeuge N, Labeyrie C, Nifle C, Laplaud D, Koch-Henriksen N, Sellebjerg FT, Soerensen PS, Pfleger CC, Rasmussen PV, Jensen MB, Frederiksen JL, Bramow S, Mathiesen HK, Schreiber KI, Magyari M, Vukusic S, Butzkueven H, Kalincik T. Natalizumab Versus Fingolimod in Patients with Relapsing-Remitting Multiple Sclerosis: A Subgroup Analysis From Three International Cohorts. CNS Drugs 2021; 35:1217-1232. [PMID: 34536228 DOI: 10.1007/s40263-021-00860-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Natalizumab has proved to be more effective than fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RRMS). Whether this association is universal for all patient groups remains to be determined. OBJECTIVE The aim of this study was to compare the relative effectiveness of natalizumab and fingolimod in RRMS subgroups defined by the baseline demographic and clinical characteristics of interest. METHODS Patients with RRMS who were given natalizumab or fingolimod were identified in a merged cohort from three international registries. Efficacy outcomes were compared across subgroups based on patients' sex, age, disease duration, Expanded Disability Status Scale (EDSS) score, and disease and magnetic resonance imaging (MRI) activity 12 months prior to treatment initiation. Study endpoints were number of relapses (analyzed with weighted negative binomial generalized linear model) and 6-month confirmed disability worsening and improvement events (weighted Cox proportional hazards model), recorded during study therapy. Each patient was weighted using inverse probability of treatment weighting based on propensity score. RESULTS A total of 5148 patients (natalizumab 1989; fingolimod 3159) were included, with a mean ± standard deviation age at baseline of 38 ± 10 years, and the majority (72%) were women. The median on-treatment follow-up was 25 (quartiles 15-41) months. Natalizumab was associated with fewer relapses than fingolimod (incidence rate ratio [IRR]; 95% confidence interval [CI]) in women (0.76; 0.65-0.88); in those aged ≤ 38 years (0.64; 0.54-0.76); in those with disease duration ≤ 7 years (0.63; 0.53-0.76); in those with EDSS score < 4 (0.75; 0.64-0.88), < 6 (0.80; 0.70-0.91), and ≥ 6 (0.52; 0.31-0.86); and in patients with pre-baseline relapses (0.74; 0.64-0.86). A higher probability of confirmed disability improvement on natalizumab versus fingolimod (hazard ratio [HR]; 95% CI) was observed among women (1.36; 1.10-1.66); those aged > 38 years (1.34; 1.04-1.73); those with disease duration > 7 years (1.33; 1.01-1.74); those with EDSS score < 6 (1.21; 1.01-1.46) and ≥ 6 (1.93; 1.11-3.34); and patients with no new MRI lesion (1.73; 1.19-2.51). CONCLUSIONS Overall, in women, younger patients, those with shorter disease durations, and patients with pre-treatment relapses, natalizumab was associated with a lower frequency of multiple sclerosis relapses than fingolimod. It was also associated with an increased chance of recovery from disability among most patients, particularly women and those with no recent MRI activity.
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Affiliation(s)
- Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, L4 East, Grattan St, Melbourne, VIC, 3050, Australia
| | - Mathilde Lefort
- Rennes University, EHESP, REPERES, EA, 7449, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Johanna Balslev Andersen
- The Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES, EA, 7449, Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.,Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | | | | | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, Canada
| | - Marc Girard
- CHUM MS Center and Universite de Montreal, Montreal, Canada
| | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | | | | | - Olga Skibina
- Department of Neuroscience, Monash University, Melbourne, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - Katherine Buzzard
- Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Anneke Van der Walt
- Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Steve Vucic
- Neurophysiology Department, Westmead Hospital, Sydney, Australia
| | - Romain Casey
- Université de Lyon, Université, Claude Bernard Lyon 1, F-69000, Lyon, France.,Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, Lyon, France.,Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, 69003, Lyon, France.,EUGENE DEVIC EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, Nancy, France.,Université de Lorraine, APEMAC, 54000, Nancy, France
| | - Gilles Edan
- CHU Pontchaillou, CIC1414 INSERM, 35000, Rennes, France
| | - Jonathan Ciron
- Department of Neurology, CHU de Toulouse, Hôpital Pierre-Paul Riquet, CRC-SEP, 31059, Toulouse Cedex 9, France
| | - Aurélie Ruet
- Neurocentre Magendie, Université de Bordeaux, 33000, Bordeaux, France.,INSERM U1215, Neurocentre Magendie, 33000, Bordeaux, France.,Department of Neurology, CHU de Bordeaux, CIC Bordeaux CIC1401, 33000, Bordeaux, France
| | - Jérôme De Sèze
- Department of Neurology and Clinical Investigation Center, CHU de Strasbourg, CIC 1434, INSERM 1434, 67000, Strasbourg, France
| | - Elisabeth Maillart
- Département de neurologie, Hôpital Pitié-Salpêtrière, APHP, Paris, France.,Centre de Ressources et de Compétences SEP, Paris, France
| | - Hélène Zephir
- CHU Lille, CRCSEP Lille, Univ Lille, U1172, 59000, Lille, France
| | - Pierre Labauge
- MS Unit, CHU de Montpellier, 34295, Montpellier Cedex 5, France.,University of Montpellier (MUSE), 34000, Montpellier, France
| | - Gilles Defer
- Department of Neurology, CHU de Caen, MS Expert Centre, Normandy University, avenue de la Côte-de-Nacre, 14033, Caen, France
| | | | - Thibault Moreau
- Department of Neurology, CHU de Dijon, EA4184, 21000, Dijon, France
| | - Eric Berger
- CHU de Besançon, Service de Neurologie 25 030, Besançon, France
| | - Pierre Clavelou
- Department of Neurology, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, Inserm, Neuro-Dol, 63000, Clermont-Ferrand, France
| | - Jean Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005, Marseille, France
| | - Bruno Stankoff
- Sorbonne Universités, UPMC Paris 06, Brain and Spine Institute, ICM, Hôpital de la Pitié Salpêtrière, Inserm UMR S 1127, CNRS UMR 7225, Paris, France.,Department of Neurology, AP-HP, Saint-Antoine Hospital, 75000, Paris, France
| | - Olivier Gout
- Department of Neurology, Fondation Rotschild, 75000, Paris, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, 30029, Nimes Cedex 9, France.,Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Univ. Montpellier, 34094, Montpellier Cedex 5, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital de Poissy, 78300, Poissy, France
| | | | | | - Olivier Casez
- Department of Neurology, CHU Grenoble Alpes, La Tronche, 38700, Grenoble, France
| | - Philippe Cabre
- Department of Neurology, CHU de la Martinique, 97200, Fort-de-France, France
| | - Alexis Montcuquet
- Department of Neurology, CHU de Limoges, Hôpital Dupuytren, 87000, Limoges, France
| | - Abir Wahab
- Department of Neurology, APHP, Hôpital Henri Mondor, 94000, Créteil, France
| | | | - Aude Maurousset
- CRC SEP and Department of Neurology, CHU de Tours, Hôpital Bretonneau, 37000, Tours, France
| | - Ivania Patry
- Department of Neurology, Hôpital Sud Francilien, 91160, Corbeil Essonnes, France
| | - Karolina Hankiewicz
- Department of Neurology, Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, 93200, Saint-Denis, France
| | - Corinne Pottier
- Department of Neurology, CH de Pontoise, Hôpital René Dubos, 95300, Pontoise, France
| | - Nicolas Maubeuge
- Department of Neurology, CHU La Milétrie, Hôpital Jean Bernard, 86000, Poitiers, France
| | - Céline Labeyrie
- Department of Neurology, CHU Bicêtre, 94275, Le Kremlin Bicêtre, France
| | - Chantal Nifle
- Department of Neurology, Centre Hospitalier de Versailles, 78150, Le Chesnay, France
| | - David Laplaud
- CHU de Nantes, Service de Neurologie & CIC015 INSERM, 44093, Nantes, France.,CRTI-Inserm U1064, 44000, Nantes, France
| | - Niels Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Thorup Sellebjerg
- Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Per Soelberg Soerensen
- Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Jette Lautrup Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Bramow
- Department of Neurology, Danish Multiple Sclerosis Centre, Copenhagen University Hospital, Rigshospitalet in Glostrup, 2600, Glostrup, Denmark
| | | | - Karen Ingrid Schreiber
- Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Neurology, The Danish Multiple Sclerosis Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, Lyon, France.,Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, 69003, Lyon, France.,Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, F-69000, Lyon, France
| | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, L4 East, Grattan St, Melbourne, VIC, 3050, Australia. .,MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
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