Cladribine versus fingolimod, natalizumab and interferon β for multiple sclerosis

Kalincik, T., Jokubaitis, V., Spelman, T., Horakova, D., Havrdova, E., Trojano, M., Lechner-Scott, J., Lugaresi, A., Prat, A., Girard, M., Duquette, P., Grammond, P., Solaro, C., Grand’Maison, F., Hupperts, R., Prevost, J., Sola, P., Ferraro, D., Terzi, M., Butler, E., Slee, M., Kermode, A., Fabis-Pedrini, M., McCombe, P., Barnett, M., Shaw, C., Hodgkinson, S. and Butzkueven, H. (2017) Cladribine versus fingolimod, natalizumab and interferon β for multiple sclerosis. Multiple Sclerosis Journal, 24 (12). pp. 1617-1626.

Abstract

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.

Item Type:	Journal Article
Murdoch Affiliation:	Institute for Immunology and Infectious Diseases
Publisher:	Sage Publications
Copyright:	© 2018 SAGE Publications
URI:	http://researchrepository.murdoch.edu.au/id/eprint/40504

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