BACKGROUND: Aggressive disease control soon after multiple sclerosis (MS) diagnosis may prevent irreversible neurological damage, and therefore early initiation of a high-efficacy disease-modifying therapy (DMT) is of clinical relevance. OBJECTIVES: Evaluate long-term clinical outcomes in patients with MS who initiated treatment with either natalizumab or a BRACETD therapy (interferon beta, glatiramer acetate, teriflunomide, or dimethyl fumarate). DESIGN: This retrospective analysis utilized data from MSBase to create a matched population allowing comparison of first-line natalizumab to first-line BRACETD. METHODS: This study included patients who initiated treatment either with natalizumab or a BRACETD DMT within 1 year of MS diagnosis and continued treatment for ⩾6 months, after which patients could switch DMTs or discontinue treatment. Patients had a minimum follow-up time of ⩾60 months from initiation. A subgroup analysis compared the natalizumab group to patients in the BRACETD group who escalated therapy after 6 months. Outcomes included unadjusted annualized relapse rates (ARRs), time-to-first relapse, time-to-first confirmed disability improvement (CDI), and time-to-first confirmed disability worsening (CDW). RESULTS: After 1:1 propensity score matching, 355 BRACETD patients were matched to 355 natalizumab patients. Patients initiating natalizumab were less likely to experience a relapse over the duration of follow-up, with ARRs [95% confidence interval (CI)] of 0.080 (0.070-0.092) for natalizumab patients and 0.191 (0.178-0.205) for BRACETD patients (p < 0.0001). A Cox regression model of time-to-first relapse showed a reduced risk of relapse for natalizumab patients [hazard ratio (95% CI) of 0.52 (0.42-0.65); p < 0.001] and a more favorable time-to-first CDI. The risk of CDW was similar between groups. The subgroup analysis showed an increased relapse risk as well as a significantly higher risk of CDW for BRACETD patients. CONCLUSION: Early initiation of natalizumab produced long-term benefits in relapse outcomes in comparison with BRACETD, regardless of a subsequent escalation in therapy.

Biogen Cambridge MA USA

Biogen Cambridge MA USA at the time of this analysis

Burnet Institute Melbourne VIC Australia

CHUM and Universite de Montreal Montreal QC Canada

Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia' University of Catania Catania Italy

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

Department of Neurology Box Hill Hospital Melbourne VIC Australia

Department of Neurology Box Hill Hospital Monash University Box Hill VIC Australia

Department of Neurology Hospital Universitario Virgen Macarena Sevilla Spain

Department of Neurology Jacobs MS Center for Treatment and Research Buffalo NY USA

Department of Neurology The Alfred Hospital Melbourne VIC Australia

Department of Neuroscience Central Clinical School Alfred Campus Monash University 6 99 Commercial Road Melbourne VIC 3004 Australia

Division of Neurology Department of Medicine Amiri Hospital Sharq Kuwait

Flinders University Adelaide SA Australia

Neuroimmunology Centre Department of Neurology The Royal Melbourne Hospital Melbourne VIC Australia

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