After multiple sclerosis relapse, switching from injectable immunomodulators to oral fingolimod was associated with fewer relapses, better disability outcomes, and great treatment persistence compared to switching to another injectable therapy.
Compared to 379 patients in the injectable group, 148 patients in the fingolimod group had lower mean annualized relapse rates (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).
Tomas Kalincik, MD, PhD, of the University of Melbourne and Royal Melbourne Hospital in Australia, and colleagues, conducted a retrospective analysis of data collected from MSBase, an international cohort study of patients with MS between 1996 and 2014. Participants included patients with relapsing-remitting MS who were switching therapy to fingolimod or and injectable immunomodulator up to 12 months after on-treatment relapse or progression of MS.
The patients had received fingolimod, interferon beta, or glatiramer acetate for a minimum of three months following the switch of therapies. The study’s 13.1 month follow-up may be too short of a time to draw definitive conclusions about relapse, however the results point to growing evidence that switching to newer MS therapies may be more effective than first-line injectables.
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.
The purpose of the study was 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.
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.