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February 12, 2020ResearchOpen Access

Effect of switching from natalizumab to moderate- vs high-efficacy DMT in clinical practice

Carrie M. Hersh, Haleigh Harris, Devon Conway, Le H. Hua
First published February 12, 2020, DOI: https://doi.org/10.1212/CPJ.0000000000000809
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.
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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.
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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.
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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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Effect of switching from natalizumab to moderate- vs high-efficacy DMT in clinical practice
Carrie M. Hersh, Haleigh Harris, Devon Conway, Le H. Hua
Neurol Clin Pract Feb 2020, 10.1212/CPJ.0000000000000809; DOI: 10.1212/CPJ.0000000000000809

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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.

  • Received September 23, 2019.
  • Accepted December 9, 2019.
  • Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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