BACKGROUND: Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide; collectively, "BRACETD") often switch to another therapy, including natalizumab or fingolimod. Here we compare the effectiveness of switching from a first-line therapy to natalizumab or fingolimod after ≥1 relapse. METHODS: Data collected prospectively in the MSBase Registry, a global, longitudinal, observational registry, were extracted on February 6, 2018. Included patients were adults with RRMS with ≥1 relapse on BRACETD therapy in the year before switching to natalizumab or fingolimod. Included patients received natalizumab or fingolimod for ≥3 months after the switch. RESULTS: Following 1:1 propensity score matching, 1000 natalizumab patients were matched to 1000 fingolimod patients. Mean (standard deviation) follow-up time was 3.02 (2.06) years after switching to natalizumab and 2.58 (1.64) years after switching to fingolimod. Natalizumab recipients had significantly lower annualized relapse rate (relative risk=0.66; 95% confidence interval [CI], 0.59-0.74), lower risk of first relapse (hazard ratio [HR]=0.69; 95% CI, 0.60-0.80), and higher confirmed disability improvement (HR=1.27; 95% CI, 1.03-1.57) than fingolimod recipients. No difference in confirmed disability worsening was observed. CONCLUSIONS: Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab than with fingolimod.

Central Clinical School and Department of Neurology Monash University and Department of Neurology Alfred Hospital Melbourne VIC Australia

Central Clinical School Monash University Melbourne VIC Australia and Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden

CISSS de Chaudière Appalaches Lévis QC Canada

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

Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia AOU Policlinico Vittorio Emanuele and Policlinico G Rodolico Catania Italy

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

Department of Neurology Faculty of Medicine University of Debrecen Debrecen Hungary

Department of Neurology Monash University Melbourne VIC Australia

Department of Neuroscience Imaging and Clinical Sciences University G d'Annunzio Chieti Italy

Division of Neurology Department of Medicine Amiri Hospital Sharq Kuwait

Dokuz Eylul University Konak Izmir Turkey

Hôpital Notre Dame Montreal QC Canada and CHUM and Université de Montréal Montreal QC Canada

KTU Medical Faculty Farabi Hospital Trabzon Turkey

Medical Faculty 19 Mayis University Samsun Turkey

Neuro Rive Sud QC Canada

Neurosciences Unit Department of Medicine and Surgery University of Parma Parma Italy

School of Medicine and Public Health University Newcastle and Department of Neurology John Hunter Hospital Hunter New England Health Newcastle NSW Australia

J Neurol. 2023 Oct;270(10):5127-5129. doi: 10.1007/s00415-023-11984-9 PubMed

Predictors of treatment switching in the Big Multiple Sclerosis Data Network