Fingolimod Improves Multiple Sclerosis Outcomes After Previous DMT Failure

brain MRI
brain MRI
Brain volume loss was smaller for all groups after treatment with fingolimod.
The following article is part of conference coverage from the 2018 Annual Meeting of the Consortium of Multiple Sclerosis Centers in Nashville, Tennesssee. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2018.

People with multiple sclerosis who initiated treatment with fingolimod after 2 previous injectable disease-modifying therapies (iDMTs) showed improved outcomes, such as a smaller degree of brain volume loss and reduced lesion counts, according to research presented at the 32nd Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 30-June 2, 2018, in Nashville, Tennessee.

PREFERMS ( Identifier: NCT01623596) was an active-controlled, open-label, multicenter, phase 4, 12-month study. Participants were randomly assigned to a fingolimod 0.5mg/d group or a preselected iDMT group. At enrollment, 46.2% (n=404) of the 875 participants were treatment-naive, and 53.8% (n=471) had been previously treated with an iDMT (glatiramer acetate or interferon). Subjects were analyzed in 3 sets: Group A included 155 participants who were previously treated with iDMT, had been randomly assigned to a new iDMT, and who were later switched to fingolimod, and these data were reported in 2 stages: A1 (pre-fingolimod) and A2 (post-fingolimod); Group B included 233 people who had been previously treated with iDMT and had been randomly assigned to fingolimod treatment; and Group C included 213 treatment-naïve participants with no previous cycles of iDMT who were randomly assigned to fingolimod treatment.

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The outcomes that were analyzed for all participants included the mean change in gadolinium-enhancing (Gd+) lesion count and the mean number of new Gd+ lesions from baseline, as well as the mean exposure-adjusted percentage of brain volume loss from baseline. Brain volume loss was smaller for all groups after treatment with fingolimod (A1, –0.902%; A2, –0.416%; B, –0.365%; C, –0.606%). Group A1 showed a mean number of 1.462 new Gd+ lesions, which was lower for all the groups after initiation of fingolimod treatment (A2, 0.542; B, 0.131; C, 0.189). No reduction in Gd+ lesion count was seen in group A1 (0.039), but after fingolimod initiation, lesion count was reduced in all groups (A2, –0.493; B, –0.386, C, –1.378).

Study investigators concluded that “after fingolimod initiation, outcomes improved in patients with two previous iDMTs. The data suggest that improvements may be seen with fingolimod irrespective of the number of iDMTs previously received.”

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Hunter SF, Thomas FP, Meng X, et al. Efficacy outcomes in patients randomized to fingolimod or injectable disease-modifying therapies in PREFER_MS_: effect of previous treatment cycles. Presented at: 2018 CMSC Annual Meeting. May 30-June 2, 2018; Nashville, Tennessee. Abstract DX52.