Escalation to natalizumab or switching among immunomodulators in relapsing multiple sclerosis

Prosperini, Luca; Giannì, Costanza; Leonardi, Laura; Giglio, Laura De; Borriello, Giovanna; Galgani, Simonetta; Pozzilli, Carlo; Gasperini, Claudio

doi:10.1177/1352458511417481

Cited by 88 publications

(93 citation statements)

References 38 publications

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“…The efficacy advantage of natalizumab compared to BRACE treatments in this study is consistent with other studies comparing these treatment options in patients who switched treatment. 23,30,31 As the population here was wholly treatment-naive, our results extend these findings to potentially inform first-line treatment decisions in clinical practice. Several studies suggest that use of high efficacy treatments earlier in disease course or earlier in treatment sequence could improve long-term patient outcomes.…”

Section: Discussionsupporting

confidence: 64%

Comparative efficacy of first-line natalizumab vs IFN-β or glatiramer acetate in relapsing MS

et al. 2016

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Background: We compared efficacy and treatment persistence in treatment-naive patients with relapsing-remitting multiple sclerosis (RRMS) initiating natalizumab compared with interferon-b (IFNb)/glatiramer acetate (GA) therapies, using propensity score-matched cohorts from observational multiple sclerosis registries. Methods: The study population initiated IFN-b/GA in the MSBase Registry or natalizumab in the Tysabri Observational Program, had $3 months of on-treatment follow-up, and had active RRMS, defined as $1 gadoliniumenhancing lesion on cerebral MRI at baseline or $1 relapse within the 12 months prior to baseline. Baseline demographics and disease characteristics were balanced between propensitymatched groups. Annualized relapse rate (ARR), time to first relapse, treatment persistence, and disability outcomes were compared between matched treatment arms in the total population (n 5 366/group) and subgroups with higher baseline disease activity.Editorial, page 97 *These authors contributed equally to this work.

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Section: Discussionsupporting

confidence: 64%

Comparative efficacy of first-line natalizumab vs IFN-β or glatiramer acetate in relapsing MS

et al. 2016

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“…Subgroup B comprised patients who had received IFNb in the year before study entry, had at least one relapse in the year before study entry, and had at least either one gadolinium-enhancing T1 lesion or nine T2 lesions at baseline. **P < 0.01, ***P < 0.001 versus placebo, † † † who had an insufficient response to previous treatment with IFNb or GA; the results of these are summarized in Table 1 [13,[40][41][42][43][44][45]. The quality of evidence from these studies is limited by the lack of a control group, and most of them are also retrospective.…”

Section: Natalizumabmentioning

confidence: 99%

Treatment options for patients with multiple sclerosis who have a suboptimal response to interferon‐β therapy

Freedman

2013

Euro J of Neurology

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Background and purpose: Although the first-line disease-modifying therapies (DMTs) interferon beta and glatiramer acetate have a favourable benefit-to-risk profile, they are only partially effective for treating relapsing-remitting multiple sclerosis (RRMS). The optimization of treatment in patients who do not show a maximum response to first-line therapy is critical for achieving the best long-term outcomes. Treatment strategies for patients with a suboptimal response include switching to another first-line DMT or a second-line DMT. Natalizumab and fingolimod are approved for RRMS with high disease activity in the European Union and Canada. Methods: A comprehensive literature search for articles published between 1990 and April 2012 was undertaken.Results: This review discusses key clinical and safety data for fingolimod and natalizumab, particularly in the patient subgroups for whom these treatments are approved. Benefit-to-risk profiles, including first-dose cardiovascular effects associated with fingolimod and the risk of progressive multifocal encephalopathy with natalizumab, are discussed. Conclusion: A descriptive comparison of fingolimod and natalizumab is provided in the context of the decision-making process of how and when to switch patients who have a suboptimal response to first-line therapy.

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“…interferon beta [IFN-β], glatiramer acetate [GA]) is associated with significantly better disease control (fewer relapses, less disease progression as measured by EDSS, and fewer new MRI lesions) compared with switching to another injectable DMT. 7,8 Furthermore, a propensity-matched analysis of the MSBase registry showed that patients who switched to natalizumab after failure of IFN-β or GA had lower relapse rates than those who switched to fingolimod (ARR decreased from 1.5 to 0.2 with natalizumab, from 1.3 to 0.4 with fingolimod; 50% relative postswitch difference in relapse hazard [p = 0.002]). 9 In a recently published analysis, treatment with natalizumab has also been shown to be associated with significantly faster recovery from a relapse compared with placebo (55% and 67% increased probability of 12-week confirmed recovery in patients with an increase in EDSS of ≥0.5 or ≥1.0 during relapse, respectively).…”

Section: Update On Efficacy and Safety Evidence With Natalizumab In Msmentioning

confidence: 99%

Use of Natalizumab in Patients with Multiple Sclerosis: 2015 Update

O’Connor

Kremenchutzky

2015

Can. J. Neurol. Sci.

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Escalation to natalizumab or switching among immunomodulators in relapsing multiple sclerosis

Abstract: We suggest that an escalation to natalizumab is more effective than switching among immunomodulators in RRMS patients who failed a first-line treatment.

Cited by 88 publications

References 38 publications

Comparative efficacy of first-line natalizumab vs IFN-β or glatiramer acetate in relapsing MS

Comparative efficacy of first-line natalizumab vs IFN-β or glatiramer acetate in relapsing MS

Treatment options for patients with multiple sclerosis who have a suboptimal response to interferon‐β therapy

Use of Natalizumab in Patients with Multiple Sclerosis: 2015 Update

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