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23-02-2015 | Multiple sclerosis | Article

Early switch to oral fingolimod may pay dividends for MS patients

medwireNews: Switching multiple sclerosis (MS) patients with on-treatment relapse from injectable immunomodulators to oral fingolimod results in better outcomes than switching them to a different injectable therapy, research suggests.

The registry-based study, which is published in JAMA Neurology, shows a lower relapse rate and improved disability outcomes among patients switched to fingolimod.

The relative risk of first on-treatment relapse was reduced by 26% in patients switched to oral fingolimod, rather than to another injectable interferon beta/glatiramer acetate. The average annualised relapse rate was also reduced, at 0.31 versus 0.42.

In addition, patients switched to fingolimod had a 47% reduced risk of disability progression and had double the likelihood of disability regression, report Tomas Kalincik (Royal Melbourne Hospital, Australia) and co-workers.

The researchers used the MSBase registry to identify 148 patients who were switched to fingolimod after experiencing disease relapse during at least 6 months of continuous interferon beta/glatiramer acetate treatment. These patients were matched by a score of the propensity to be given fingolimod to 379 who were switched to a different interferon beta/glatiramer acetate treatment.

In a linked editorial, Olaf Stüve (University of Texas Southwestern Medical Center, Dallas, USA) and Diego Centonze (Tor Vergata University and Hospital, Rome, Italy) say that such a study design has drawbacks that could slant the findings in favour of fingolimod.

These include some patients being switched between different interferon preparations, which would simply confirm their lack of response to the medication, and the lack of consistent testing for interferon-neutralising antibodies. They also say that the median 13.1-month follow-up “appears too short to draw definite conclusions on the relapse rate”.

Nevertheless, the editorialists say that such studies “can still provide crucial information to support decision making relevant for MS management in real-world clinical practice.” They add that early therapy switching is justified if it can limit tissue damage and prevent disability.

The study findings also show that patients who switched to oral fingolimod were more adherent to the therapy, with 17.5% discontinuing within 24 months compared with 26.8% of those who switched to another injectable interferon beta/glatiramer acetate.

Stüve and Centonze conclude that “a consistent bulk of data are now available to indicate that escalating to the more effective medications natalizumab or fingolimod should be an early consideration for most patients with breakthrough disease.”

By Eleanor McDermid

medwireNews is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2015

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