Disability progression in relapse-free multiple sclerosis patients on fingolimod versus interferon-beta/glatiramer acetate.

Abstract

BACKGROUND:

Disability progression independent of relapses (PIRA) has been described as a frequent phenomenon in relapsing-remitting multiple sclerosis (RRMS).

OBJECTIVE:

To compare the occurrence of disability progression in relapse-free RRMS patients on interferon-beta/glatiramer acetate (IFN/GA) versus fingolimod.

METHODS:

This study is based on data from the Swiss association for joint tasks of health insurers. Time to relapse and 12-month confirmed disability progression were compared between treatment groups using multivariable Cox regression analysis with confounder adjustment. Inverse-probability weighting was applied to correct for the bias that patients on fingolimod have a higher chance to remain relapse-free than patients on IFN/GA.

RESULTS:

We included 1640 patients (64% IFN/GA, 36% fingolimod, median total follow-up time = 4-5 years). Disease-modifying treatment (DMT) groups were well balanced with regard to potential confounders. Disability progression was observed in 155 patients (8.8%) on IFN/GA and 51 (7.6%) on fingolimod, of which 44 and 23 were relapse-free during the initial DMT, respectively. Adjusted standard regression analysis on all patients indicated that those on fingolimod experience less frequently disability progression compared with IFN/GA (hazard ratio = 0.53 (95% confidence interval = 0.37-0.76)). After bias correction, this was also true for patients without relapses (hazard ratio=0.56 (95% confidence interval = 0.32-0.98).

CONCLUSION:

Our analysis indicates that fingolimod is superior to IFN/GA in preventing disability progression in both relapsing and relapse-free, young, newly diagnosed RRMS patients.

• Authors: Viktor von Wyl, Pascal Benkert, André Moser, Johannes Lorscheider, Bernhard Décard, Peter Hänni, Carmen Lienert, Jens Kuhle, Tobias Derfuss, Ludwig Kappos, Özgür Yaldizli
• Journal: Multiple sclerosis (Houndmills, Basingstoke, England) (Mult Scler) Vol. 27 Issue 3 Pg. 439-448 (03 2021) ISSN: 1477-0970 [Electronic] England
• PMID: 32463336 (Publication Type: Journal Article)

Chemical References

• Immunosuppressive Agents
• Glatiramer Acetate
• Interferon-beta
• Fingolimod Hydrochloride

Topics

• Fingolimod Hydrochloride (therapeutic use)
• Glatiramer Acetate (therapeutic use)
• Humans
• Immunosuppressive Agents
• Interferon-beta
• Multiple Sclerosis
• Multiple Sclerosis, Relapsing-Remitting (drug therapy)
• Recurrence