Ocrelizumab versus fingolimod after natalizumab cessation in multiple sclerosis: an observational study.

Abstract

BACKGROUND:

Exit strategy after natalizumab cessation in multiple sclerosis (MS) is a crucial point because the risk of disease reactivation is high during this period. The objective of this observational study was to compare ocrelizumab to fingolimod after natalizumab cessation in patients with relapsing-remitting multiple sclerosis (RRMS).

METHODS:

All RRMS patients starting fingolimod or ocrelizumab within 6 weeks after natalizumab cessation were included. The primary endpoint was the annualized relapse rate (ARR) at 1 year.

RESULTS:

We included 54 patients receiving fingolimod and 48 patients receiving ocrelizumab after natalizumab cessation. In multivariate analysis, ARR at 1 year was significantly lower in the ocrelizumab group than in the fingolimod group (0.12 ± 0.39 versus 0.41 ± 0.71, p = 0.026), i.e. a 70.7% lower relapse rate. The cumulative probability of relapses at 1 year was 31.5% (17/54 patients) with fingolimod and 10.4% (5/48 patients) with ocrelizumab, corresponding to a hazard ratio of 3.4 (95% confidence interval: 1.1-11, p = 0.04).

CONCLUSIONS:

Our results suggest ocrelizumab is potentially a better exit strategy than fingolimod after natalizumab cessation.

• Authors: Kévin Bigaut, Laurent Kremer, Thibaut Fabacher, Guido Ahle, Mathilde Goudot, Marie Fleury, Claude Gaultier, Sylvie Courtois, Nicolas Collongues, Jérôme de Seze
• Journal: Journal of neurology (J Neurol) Vol. 269 Issue 6 Pg. 3295-3300 (Jun 2022) ISSN: 1432-1459 [Electronic] Germany
• PMID: 34982200 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Chemical References

• Antibodies, Monoclonal, Humanized
• Immunologic Factors
• Immunosuppressive Agents
• Natalizumab
• ocrelizumab
• Fingolimod Hydrochloride

Topics

• Antibodies, Monoclonal, Humanized
• Fingolimod Hydrochloride (adverse effects)
• Humans
• Immunologic Factors (adverse effects)
• Immunosuppressive Agents (adverse effects)
• Multiple Sclerosis
• Multiple Sclerosis, Relapsing-Remitting (drug therapy)
• Natalizumab (adverse effects)
• Recurrence