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.

Brain and Mind Centre Sydney NSW Australia

CISSS de Chaudière Appalache Levis QC Canada

Clinique Neuro Rive Sud Greenfield Park QC Canada

CORe Department of Medicine The University of Melbourne Melbourne VIC Australia Department of Neurology The Royal Melbourne Hospital Melbourne VIC Australia

CSSS de Saint Jérôme Saint Jerome QC Canada

Department of Basic Medical Sciences Neuroscience and Sense Organs University of Bari Bari Italy

Department of Neurology and Center of Clinical Neuroscience General University Hospital and Charles University Prague Prague Czech Republic

Department of Neurology The Royal Melbourne Hospital Melbourne VIC Australia Department of Medicine The University of Melbourne Melbourne VIC Australia

Department of Neurology The Royal Melbourne Hospital Melbourne VIC Australia Department of Medicine The University of Melbourne Melbourne VIC Australia Department of Neurology Box Hill Hospital Monash University Melbourne VIC Australia

Department of Neuroscience Imaging and Clinical Sciences University G d'Annunzio Chieti Italy Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy

Flinders University Adelaide SA Australia

Geelong Hospital Geelong VIC Australia

Hôpital Notre Dame Montreal QC Canada CHUM Universite de Montreal Montreal QC Canada

Liverpool Hospital Sydney NSW Australia

Medical Faculty 19 Mayis University Samsun Turkey

Monash Medical Centre Melbourne VIC Australia

Nuovo Ospedale Civile Sant'Agostino Estense Modena Italy

Ospedale Padre Antero Micone Genoa Italy

The Perron Institute The University of Western Australia Perth WA Australia

The Perron Institute The University of Western Australia Perth WA Australia Institute for Immunology and Infectious Diseases Murdoch University Perth WA Australia

The University of Newcastle Newcastle NSW Australia

The University of Queensland Brisbane QLD Australia Royal Brisbane and Women's Hospital Herston QLD Australia

Zuyderland Ziekenhuis Sittard The Netherlands

Mult Scler. 2017 Dec;23(14):NP1. doi: 10.1177/1352458517735739. PubMed

Citace poskytuje Crossref.org

Long-term clinical outcomes in patients with multiple sclerosis who are initiating disease-modifying therapy with natalizumab compared with BRACETD first-line therapies

Comparative effectiveness of cladribine tablets versus other oral disease-modifying treatments for multiple sclerosis: Results from MSBase registry

Comparative Effectiveness and Cost-Effectiveness of Natalizumab and Fingolimod in Patients with Inadequate Response to Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis in the United Kingdom