Medicine (RMH) - Research Publications

Permanent URI for this collection

http://hdl.handle.net/11343/193

Filters

2015 - 2018 2
2
Reset filters

Settings
Statistics
Citations
Author: Bahlo, Melanie × Author: Butzkueven, Helmut × Author: Kalincik, Tomas × Author: Spelman, Timothy × End date: 2019 × Start date: 2010 ×

Search Results

Now showing 1 - 2 of 2
  • Item
    Thumbnail Image
    Cladribine versus fingolimod, natalizumab and interferon for multiple sclerosis
    Kalincik, T ; Jokubaitis, V ; Spelman, T ; Horakova, D ; Havrdova, E ; Trojano, M ; Lechner-Scott, J ; Lugaresi, A ; Prat, A ; Girard, M ; Duquette, P ; Grammond, P ; Solaro, C ; Grand'Maison, F ; Hupperts, R ; Prevost, J ; Sola, P ; Ferraro, D ; Terzi, M ; Butler, E ; Slee, M ; Kermode, A ; Fabis-Pedrini, M ; McCombe, P ; Barnett, M ; Shaw, C ; Hodgkinson, S ; Butzkueven, H (SAGE PUBLICATIONS LTD, 2018-10)
    OBJECTIVE: This propensity score-matched analysis from MSBase compared the effectiveness of cladribine with interferon β, fingolimod or natalizumab. METHODS: We identified all patients with relapse-onset multiple sclerosis, exposure to the study therapies and ⩾1-year on-treatment follow-up from MSBase. Three pairwise propensity score-matched analyses compared treatment outcomes over 1 year. The outcomes were hazards of first relapse, disability accumulation and disability improvement events. Sensitivity analyses were completed. RESULTS: The cohorts consisted of 37 (cladribine), 1940 (interferon), 1892 (fingolimod) and 1410 patients (natalizumab). The probability of experiencing a relapse on cladribine was lower than on interferon ( p = 0.05), similar to fingolimod ( p = 0.31) and higher than on natalizumab ( p = 0.042). The probability of disability accumulation on cladribine was similar to interferon ( p = 0.37) and fingolimod ( p = 0.089) but greater than natalizumab ( p = 0.021). The probability of disability improvement was higher on cladribine than interferon ( p = 0.00017), fingolimod ( p = 0.0025) or natalizumab ( p = 0.00099). Sensitivity analyses largely confirmed the above results. CONCLUSION: Cladribine is an effective therapy for relapse-onset multiple sclerosis. Its effect on relapses is comparable to fingolimod and its effect on disability accrual is comparable to interferon β and fingolimod. Cladribine may potentially associate with superior recovery from disability relative to interferon, fingolimod and natalizumab.
  • Item
    Thumbnail Image
    Comparison of Switch to Fingolimod or Interferon Beta/Glatiramer Acetate in Active Multiple Sclerosis
    He, A ; Spelman, T ; Jokubaitis, V ; Havrdova, E ; Horakova, D ; Trojano, M ; Lugaresi, A ; Izquierdo, G ; Grammond, P ; Duquette, P ; Girard, M ; Pucci, E ; Iuliano, G ; Alroughani, R ; Oreja-Guevara, C ; Fernandez-Bolanos, R ; Grand'Maison, F ; Sola, P ; Spitaleri, D ; Granella, F ; Terzi, M ; Lechner-Scott, J ; Van Pesch, V ; Hupperts, R ; Luis Sanchez-Menoyo, J ; Hodgkinson, S ; Rozsa, C ; Verheul, F ; Butzkueven, H ; Kalincik, T (AMER MEDICAL ASSOC, 2015-04)
    IMPORTANCE: After multiple sclerosis (MS) relapse while a patient is receiving an injectable disease-modifying drug, many physicians advocate therapy switch, but the relative effectiveness of different switch decisions is often uncertain. OBJECTIVE: To compare the effect of the oral immunomodulator fingolimod with that of all injectable immunomodulators (interferons or glatiramer acetate) on relapse rate, disability, and treatment persistence in patients with active MS. DESIGN, SETTING, AND PARTICIPANTS: Matched retrospective analysis of data collected prospectively from MSBase, an international, observational cohort study. The MSBase cohort represents a population of patients with MS monitored at large MS centers. The analyzed data were collected between July 1996 and April 2014. Participants included patients with relapsing-remitting MS who were switching therapy to fingolimod or injectable immunomodulators up to 12 months after on-treatment clinical disease activity (relapse or progression of disability), matched on demographic and clinical variables. Median follow-up duration was 13.1 months (range, 3-80). Indication and attrition bias were controlled with propensity score matching and pairwise censoring, respectively. Head-to-head analyses of relapse and disability outcomes used paired, weighted, negative binomial models or frailty proportional hazards models adjusted for magnetic resonance imaging variables. Sensitivity analyses were conducted. EXPOSURES: Patients had received fingolimod, interferon beta, or glatiramer acetate for a minimum of 3 months following a switch of immunomodulatory therapy. MAIN OUTCOMES AND MEASURES: Annualized relapse rate and proportion of relapse-free patients, as well as the proportion of patients without sustained disability progression. RESULTS: Overall, 379 patients in the injectable group were matched to 148 patients in the fingolimod group. The fingolimod group had a lower mean annualized relapse rate (0.31 vs 0.42; 95% CI, 0.02-0.19; P=.009), lower hazard of first on-treatment relapse (hazard ratio [HR], 0.74; 95% CI, 0.56-0.98; P=.04), lower hazard of disability progression (HR, 0.53; 95% CI, 0.31-0.91; P=.02), higher rate of disability regression (HR, 2.0; 95% CI, 1.2-3.3; P=.005), and lower hazard of treatment discontinuation (HR, 0.55; P=.04) compared with the injectable group. CONCLUSIONS AND RELEVANCE: Switching from injectable immunomodulators to fingolimod is associated with fewer relapses, more favorable disability outcomes, and greater treatment persistence compared with switching to another injectable preparation following on-treatment activity of MS.