Comparing Moderate vs High Efficacy DMT After Natalizumab Discontinuation for MS

The following article is part of coverage from the American Academy of Neurology’s Annual Meeting (AAN 2020). Due to the global COVID-19 pandemic, the Academy made the necessary decision to cancel the meeting originally scheduled for April 25–May 1, 2020, in Toronto. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

Switching from natalizumab to moderate disease modifying therapy (DMT) vs switching to high efficacy therapy (HET) in multiple sclerosis (MS) patients was associated with lower rates of no disease activity and higher risk for disability accumulation by 24 months, according to study results intended to be presented at the annual meeting of the American Academy of Neurology (AAN 2020).

Natalizumab is an effective treatment option for MS and discontinuation of the treatment may trigger rebound disease. However, in light of the possible adverse effects associated with long-term use of natalizumab, other treatment options for MS are important. Because a previous study revealed an increased risk for early disease activity per magnetic resonance imaging (MRI) by 6 months after switching from natalizumab to moderate DMT vs HET, the goal of the current study was to assess the effect of this treatment change at 24 month follow-up.

The study cohort included 556 participants with MS from 2 MS centers who were required to discontinue natalizumab treatment for various reasons, including progressive multifocal leukoencephalopathy risk (54.9%), breakthrough disease (15.3%), and adverse effects (17.3%). Of these, 270 participants (48.6%) were switched to moderate DMT (dimethyl fumarate: 130 participants; fingolimoid: 140 participants) and 130 (23.4%) were switched to HET (ocrelizumab: 106 participants; rituximab: 17 participants; alemtuzumab: 7 participants) were assessed using propensity score weighting.

The study outcomes included the annualized relapse rate and proportions with new T2 and/or gadolinium enhancing lesions, absence of disease activity (a composite measure of no relapses and/or MRI activity), and 20% worsening of the timed 25-foot walk and 9-hole peg test.

While there was no statistically significant difference in annualized relapse rate between moderate DMT and HET (odds ratio [OR], 1.44; 95% CI, 0.69-1.59; P=.334), participants who switched to moderate DMT had higher percentages of new T2 lesions (OR, 2.15; 95% CI, 1.18-3.01; P=.011), new gadolinium enhancing lesions (OR, 1.99; 95% CI, 1.12-2.73; P=.022) and 20% worsening of the timed 25-foot walk (OR, 1.83; 95% CI, 1.06-3.02; P=.043) and 9-hole peg test (OR, 1.81; 95% CI, 1.05-3.56; P=.044). Furthermore, the percentage of patients with absence of disease activity was lower in the group of patients treated with moderate DMT vs HET (OR, 0.41; 95% CI, 0.21-0.71; P=.004).

“[Natalizumab] switchers to [moderate] DMT had lower cumulative probability of no disease activity by 24 months and were at higher risk of disability accumulation,” concluded the researchers.

Reference

Hersh CM, Harris H, Conway D, Hua LH. Impact of switching from natalizumab to a moderate versus high efficacy DMT in clinical practice at 24-month follow-up. Intended to be presented at the 2020 annual meeting of the American Academy of Neurology. Abstract S29.008.

Visit Neurology Advisor‘s conference section for complete AAN 2020 coverage.