TY - JOUR
T1 - Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis
AU - Roos, Izanne
AU - Sharmin, Sifat
AU - Malpas, Charles
AU - Ozakbas, Serkan
AU - Lechner-Scott, Jeannette
AU - Hodgkinson, Suzanne
AU - Alroughani, Raed
AU - Eichau Madueño, Sara
AU - Boz, Cavit
AU - van der Walt, Anneke
AU - Butzkueven, Helmut
AU - Buzzard, Katherine
AU - Skibina, Olga
AU - Foschi, Matteo
AU - Grand’Maison, Francois
AU - John, Nevin
AU - Grammond, Pierre
AU - Terzi, Murat
AU - Prévost, Julie
AU - Barnett, Michael
AU - Laureys, Guy
AU - Van Hijfte, Liesbeth
AU - Luis Sanchez-Menoyo, Jose
AU - Blanco, Yolanda
AU - Oh, Jiwon
AU - McCombe, Pamela
AU - Ramo Tello, Cristina
AU - Soysal, Aysun
AU - Prat, Alexandre
AU - Duquette, Pierre
AU - Yamout, Bassem I.
AU - Khoury, Samia
AU - van Pesch, Vincent
AU - Macdonell, Richard
AU - José Sá, Maria
AU - Slee, Mark
AU - Kuhle, Jens
AU - Maimone, Davide
AU - Spitaleri, Daniele L.A.
AU - Willekens, Barbara
AU - Asmi, Abdallah Al
AU - Tallantyre, Emma
AU - Robertson, Neil P.
AU - Coles, Alasdair
AU - L Brown, J. William
AU - Kalincik, Tomas
PY - 2024/8
Y1 - 2024/8
N2 - Background: Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking.Objectives: To compare the effectiveness of cladribine against fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS.Methods: Patients with relapsing-remitting MS treated with cladribine, fingolimod, natalizumab, ocrelizumab or alemtuzumab were identified in the global MSBase cohort and two additional UK centres. Patients were followed for ⩾6/12 and had ⩾3 in-person disability assessments. Patients were matched using propensity score. Four pairwise analyses compared annualised relapse rates (ARRs) and disability outcomes.Results: The eligible cohorts consisted of 853 (fingolimod), 464 (natalizumab), 1131 (ocrelizumab), 123 (alemtuzumab) or 493 (cladribine) patients. Cladribine was associated with a lower ARR than fingolimod (0.07 vs. 0.12, p = 0.006) and a higher ARR than natalizumab (0.10 vs. 0.06, p = 0.03), ocrelizumab (0.09 vs. 0.05, p = 0.008) and alemtuzumab (0.17 vs. 0.04, p < 0.001). Compared to cladribine, the risk of disability worsening did not differ in patients treated with fingolimod (hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.47–2.47) or alemtuzumab (HR 0.73, 95% CI 0.26–2.07), but was lower for patients treated with natalizumab (HR 0.35, 95% CI 0.13–0.94) and ocrelizumab (HR 0.45, 95% CI 0.26–0.78). There was no evidence for a difference in disability improvement.Conclusion: Cladribine is an effective therapy that can be viewed as a step up in effectiveness from fingolimod, but is less effective than the most potent intravenous MS therapies.
AB - Background: Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking.Objectives: To compare the effectiveness of cladribine against fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS.Methods: Patients with relapsing-remitting MS treated with cladribine, fingolimod, natalizumab, ocrelizumab or alemtuzumab were identified in the global MSBase cohort and two additional UK centres. Patients were followed for ⩾6/12 and had ⩾3 in-person disability assessments. Patients were matched using propensity score. Four pairwise analyses compared annualised relapse rates (ARRs) and disability outcomes.Results: The eligible cohorts consisted of 853 (fingolimod), 464 (natalizumab), 1131 (ocrelizumab), 123 (alemtuzumab) or 493 (cladribine) patients. Cladribine was associated with a lower ARR than fingolimod (0.07 vs. 0.12, p = 0.006) and a higher ARR than natalizumab (0.10 vs. 0.06, p = 0.03), ocrelizumab (0.09 vs. 0.05, p = 0.008) and alemtuzumab (0.17 vs. 0.04, p < 0.001). Compared to cladribine, the risk of disability worsening did not differ in patients treated with fingolimod (hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.47–2.47) or alemtuzumab (HR 0.73, 95% CI 0.26–2.07), but was lower for patients treated with natalizumab (HR 0.35, 95% CI 0.13–0.94) and ocrelizumab (HR 0.45, 95% CI 0.26–0.78). There was no evidence for a difference in disability improvement.Conclusion: Cladribine is an effective therapy that can be viewed as a step up in effectiveness from fingolimod, but is less effective than the most potent intravenous MS therapies.
KW - Cladribine
KW - comparative effectiveness
KW - multiple sclerosis
KW - observational studies
UR - http://www.scopus.com/inward/record.url?scp=85200232897&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/2026836
U2 - 10.1177/13524585241267211
DO - 10.1177/13524585241267211
M3 - Article
C2 - 39087208
AN - SCOPUS:85200232897
SN - 1352-4585
VL - 30
SP - 1163
EP - 1175
JO - Multiple Sclerosis Journal
JF - Multiple Sclerosis Journal
IS - 9
ER -