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Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center

Background: Natalizumab (NTZ) and fingolimod (FTY) are second-line disease modifying treatments (DMTs) approved for Relapsing – Remitting Multiple Sclerosis (RRMS). Few studies are available on a direct comparison between NTZ and FTY, based on post-marketing experience, with conflicting results and...

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Autores principales: Boziki, Marina, Bakirtzis, Christos, Giantzi, Virginia, Sintila, Styliani-Aggeliki, Kallivoulos, Stylianos, Afrantou, Theodora, Nikolaidis, Ioannis, Ioannidis, Panagiotis, Karapanayiotides, Theodoros, Koutroulou, Ioanna, Parissis, Dimitrios, Grigoriadis, Nikolaos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419322/
https://www.ncbi.nlm.nih.gov/pubmed/34497577
http://dx.doi.org/10.3389/fneur.2021.699844
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author Boziki, Marina
Bakirtzis, Christos
Giantzi, Virginia
Sintila, Styliani-Aggeliki
Kallivoulos, Stylianos
Afrantou, Theodora
Nikolaidis, Ioannis
Ioannidis, Panagiotis
Karapanayiotides, Theodoros
Koutroulou, Ioanna
Parissis, Dimitrios
Grigoriadis, Nikolaos
author_facet Boziki, Marina
Bakirtzis, Christos
Giantzi, Virginia
Sintila, Styliani-Aggeliki
Kallivoulos, Stylianos
Afrantou, Theodora
Nikolaidis, Ioannis
Ioannidis, Panagiotis
Karapanayiotides, Theodoros
Koutroulou, Ioanna
Parissis, Dimitrios
Grigoriadis, Nikolaos
author_sort Boziki, Marina
collection PubMed
description Background: Natalizumab (NTZ) and fingolimod (FTY) are second-line disease modifying treatments (DMTs) approved for Relapsing – Remitting Multiple Sclerosis (RRMS). Few studies are available on a direct comparison between NTZ and FTY, based on post-marketing experience, with conflicting results and reporting relatively short follow-up period. Aim: We hereby report real-world experience of a MS Center with respect to NTZ vs. FTY comparison in terms of efficacy and safety, referencing long-term follow-up. Methods: We used retrospective data for all patients that received 2nd-line treatment NTZ (since May 2007) or FTY (since September 2011). Primary endpoints were, among others, annual EDSS score (mean change from baseline), time to disability worsening or improvement, Annualized Relapse Rate (ARR) after 12 and 24 months and upon total treatment duration, time to first relapse and time to radiological progression. Results: A total of 138 unmatched patients, 84 treated with NTZ and 54 treated with FTY were included. Following Propensity Score (PS) matching, 31 patients in each group were retained. Mean follow-up period for NTZ- and FTY-treated patients was 4.43 ± 0.29 and 3.59 ± 0.32 years (p = 0.057), respectively. In the matched analysis, time to disability improvement and time to disability worsening was comparable between groups. A higher proportion of patients remained free of relapse under NTZ, compared to FTY (Log Rank test p = 0.021, HR: 0.25, 95% CI: 0.08–0.8), as well as free of MRI activity (Log Rank test p = 0.006, HR: 0.26, 95% CI: 0.08–0.6). Treatment discontinuation due to MRI activity was significantly higher for FTY-treated patients compared to NTZ (Log Rank test p = 0.019, HR: 0.12, 95% CI: 0.05–0.76). Conclusion: Our results indicate toward NTZ superiority with respect to relapse and MRI activity outcomes. The fact that NTZ-treated patients may achieve long-standing clinical and radiological remission points toward the need for long follow-up data.
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spelling pubmed-84193222021-09-07 Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center Boziki, Marina Bakirtzis, Christos Giantzi, Virginia Sintila, Styliani-Aggeliki Kallivoulos, Stylianos Afrantou, Theodora Nikolaidis, Ioannis Ioannidis, Panagiotis Karapanayiotides, Theodoros Koutroulou, Ioanna Parissis, Dimitrios Grigoriadis, Nikolaos Front Neurol Neurology Background: Natalizumab (NTZ) and fingolimod (FTY) are second-line disease modifying treatments (DMTs) approved for Relapsing – Remitting Multiple Sclerosis (RRMS). Few studies are available on a direct comparison between NTZ and FTY, based on post-marketing experience, with conflicting results and reporting relatively short follow-up period. Aim: We hereby report real-world experience of a MS Center with respect to NTZ vs. FTY comparison in terms of efficacy and safety, referencing long-term follow-up. Methods: We used retrospective data for all patients that received 2nd-line treatment NTZ (since May 2007) or FTY (since September 2011). Primary endpoints were, among others, annual EDSS score (mean change from baseline), time to disability worsening or improvement, Annualized Relapse Rate (ARR) after 12 and 24 months and upon total treatment duration, time to first relapse and time to radiological progression. Results: A total of 138 unmatched patients, 84 treated with NTZ and 54 treated with FTY were included. Following Propensity Score (PS) matching, 31 patients in each group were retained. Mean follow-up period for NTZ- and FTY-treated patients was 4.43 ± 0.29 and 3.59 ± 0.32 years (p = 0.057), respectively. In the matched analysis, time to disability improvement and time to disability worsening was comparable between groups. A higher proportion of patients remained free of relapse under NTZ, compared to FTY (Log Rank test p = 0.021, HR: 0.25, 95% CI: 0.08–0.8), as well as free of MRI activity (Log Rank test p = 0.006, HR: 0.26, 95% CI: 0.08–0.6). Treatment discontinuation due to MRI activity was significantly higher for FTY-treated patients compared to NTZ (Log Rank test p = 0.019, HR: 0.12, 95% CI: 0.05–0.76). Conclusion: Our results indicate toward NTZ superiority with respect to relapse and MRI activity outcomes. The fact that NTZ-treated patients may achieve long-standing clinical and radiological remission points toward the need for long follow-up data. Frontiers Media S.A. 2021-08-23 /pmc/articles/PMC8419322/ /pubmed/34497577 http://dx.doi.org/10.3389/fneur.2021.699844 Text en Copyright © 2021 Boziki, Bakirtzis, Giantzi, Sintila, Kallivoulos, Afrantou, Nikolaidis, Ioannidis, Karapanayiotides, Koutroulou, Parissis and Grigoriadis. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Boziki, Marina
Bakirtzis, Christos
Giantzi, Virginia
Sintila, Styliani-Aggeliki
Kallivoulos, Stylianos
Afrantou, Theodora
Nikolaidis, Ioannis
Ioannidis, Panagiotis
Karapanayiotides, Theodoros
Koutroulou, Ioanna
Parissis, Dimitrios
Grigoriadis, Nikolaos
Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center
title Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center
title_full Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center
title_fullStr Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center
title_full_unstemmed Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center
title_short Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center
title_sort long-term efficacy outcomes of natalizumab vs. fingolimod in patients with highly active relapsing-remitting multiple sclerosis: real-world data from a multiple sclerosis reference center
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419322/
https://www.ncbi.nlm.nih.gov/pubmed/34497577
http://dx.doi.org/10.3389/fneur.2021.699844
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