Ocrelizumab versus fingolimod after natalizumab cessation in multiple sclerosis: an observational study

J Neurol. 2022 Jun;269(6):3295-3300. doi: 10.1007/s00415-021-10950-7. Epub 2022 Jan 4.

Abstract

Background: Exit strategy after natalizumab cessation in multiple sclerosis (MS) is a crucial point because the risk of disease reactivation is high during this period. The objective of this observational study was to compare ocrelizumab to fingolimod after natalizumab cessation in patients with relapsing-remitting multiple sclerosis (RRMS).

Methods: All RRMS patients starting fingolimod or ocrelizumab within 6 weeks after natalizumab cessation were included. The primary endpoint was the annualized relapse rate (ARR) at 1 year.

Results: We included 54 patients receiving fingolimod and 48 patients receiving ocrelizumab after natalizumab cessation. In multivariate analysis, ARR at 1 year was significantly lower in the ocrelizumab group than in the fingolimod group (0.12 ± 0.39 versus 0.41 ± 0.71, p = 0.026), i.e. a 70.7% lower relapse rate. The cumulative probability of relapses at 1 year was 31.5% (17/54 patients) with fingolimod and 10.4% (5/48 patients) with ocrelizumab, corresponding to a hazard ratio of 3.4 (95% confidence interval: 1.1-11, p = 0.04).

Conclusions: Our results suggest ocrelizumab is potentially a better exit strategy than fingolimod after natalizumab cessation.

Keywords: Fingolimod; Multiple sclerosis; Natalizumab; Ocrelizumab; Switch.

Publication types

  • Observational Study

MeSH terms

  • Antibodies, Monoclonal, Humanized
  • Fingolimod Hydrochloride / adverse effects
  • Humans
  • Immunologic Factors / adverse effects
  • Immunosuppressive Agents / adverse effects
  • Multiple Sclerosis*
  • Multiple Sclerosis, Relapsing-Remitting* / drug therapy
  • Natalizumab / adverse effects
  • Recurrence

Substances

  • Antibodies, Monoclonal, Humanized
  • Immunologic Factors
  • Immunosuppressive Agents
  • Natalizumab
  • ocrelizumab
  • Fingolimod Hydrochloride