• Chao Zhu, Zhen Zhou, Izanne Roos, Daniel Merlo, Tomas Kalincik, Serkan Ozakbas, Olga Skibina, Jens Kuhle, Suzanne Hodgkinson, Cavit Boz, Raed Alroughani, Jeannette Lechner-Scott, Michael Barnett, Guillermo Izquierdo, Alexandre Prat, Dana Horakova, Eva Kubala Havrdova, Richard Macdonell, Francesco Patti, Samia Joseph Khoury, Mark Slee, Rana Karabudak, Marco Onofrj, Vincent Van Pesch, Julie Prevost, Mastura Monif, Vilija Jokubaitis, Anneke van der Walt, Helmut Butzkueven, and MSBase Study Group.
• Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia Chao.Zhu@monash.edu.
• J. Neurol. Neurosurg. Psychiatr. 2022 Dec 1; 93 (12): 133013371330-1337.

BackgroundTo compare the effectiveness and treatment persistence of ocrelizumab, cladribine and natalizumab in patients with relapsing-remitting multiple sclerosis switching from fingolimod.MethodsUsing data from MSBase registry, this multicentre cohort study included subjects who had used fingolimod for ≥6 months and then switched to ocrelizumab, cladribine or natalizumab within 3 months after fingolimod discontinuation. We analysed relapse and disability outcomes after balancing covariates using an inverse-probability-treatment-weighting method. Propensity scores for the three treatments were obtained using multinomial-logistic regression. Due to the smaller number of cladribine users, comparisons of disability outcomes were limited to natalizumab and ocrelizumab.ResultsOverall, 1045 patients switched to ocrelizumab (n=445), cladribine (n=76) or natalizumab (n=524) after fingolimod. The annualised relapse rate (ARR) for ocrelizumab was 0.07, natalizumab 0.11 and cladribine 0.25. Compared with natalizumab, the ARR ratio (95% confidence interval [CI]) was 0.67 (0.47 to 0.96) for ocrelizumab and 2.31 (1.30 to 4.10) for cladribine; the hazard ratio (95% CI) for time to first relapse was 0.57 (0.40 to 0.83) for ocrelizumab and 1.18 (0.47 to 2.93) for cladribine. Ocrelizumab users had an 89% lower discontinuation rate (95% CI, 0.07 to 0.20) than natalizumab, but also a 51% lower probability of confirmed disability improvement (95% CI, 0.32 to 0.73). There was no difference in disability accumulation.ConclusionAfter fingolimod cessation, ocrelizumab and natalizumab were more effective in reducing relapses than cladribine. Due to the low ARRs in all three treatment groups, additional observation time is required to determine if statistical difference in ARRs results in long-term disability differences.© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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