Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis
Por:
Roos, I, Sharmin, S, Malpas, C, Ozakbas, S, Lechner-Scott, J, Hodgkinson, S, Alroughani, R, Madueno, SE, Boz, C, van der Walt, A, Butzkueven, H, Buzzard, K, Skibina, O, Foschi, M, Grand'Maison, F, John, N, Grammond, P, Terzi, M, Prevost, J, Barnett, M, Laureys, G, Van Hijfte, L, Sanchez-Menoyo, JL, Blanco, Y, Oh, J, Mccombe, P, Tello, CR, Soysal, A, Prat, A, Duquette, P, Yamout, B, Khoury, S, van Pesch, V, Macdonell, R, Sa, MJ, Slee, M, Kuhle, J, Maimone, D, Spitaleri, DL, Willekens, B, Asmi, AA, Tallantyre, E, Robertson, NP, Coles, A, Brown, JW and Kalincik, T
Publicada:
1 ago 2024
Ahead of Print:
1 ago 2024
Resumen:
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.
Filiaciones:
Roos, I:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, L7 635 Elizabeth St, Melbourne, Vic 3002, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Sharmin, S:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, L7 635 Elizabeth St, Melbourne, Vic 3002, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Malpas, C:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, L7 635 Elizabeth St, Melbourne, Vic 3002, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Ozakbas, S:
Dokuz Eylul Univ, Konak, Izmir, Turkiye
Lechner-Scott, J:
Univ Newcastle, Hunter Med Res Inst, John Hunter Hosp, Newcastle, NSW, Australia
John Hunter Hosp, Hunter New England Hlth, Newcastle, NSW, Australia
Hodgkinson, S:
UNSW, Ingham Inst, Immune Tolerance Lab, Sydney, NSW, Australia
UNSW, Dept Med, Sydney, NSW, Australia
Alroughani, R:
Amiri Hosp, Dept Med, Div Neurol, Sharq, Kuwait
Madueno, SE:
Hosp Univ Virgen Macarena, Seville, Spain
Boz, C:
Karadeniz Tech Univ, Fac Med, Trabzon, Turkiye
van der Walt, A:
Alfred Hosp, Dept Neurol, Melbourne, Vic, Australia
Monash Univ, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Butzkueven, H:
Alfred Hosp, Dept Neurol, Melbourne, Vic, Australia
Monash Univ, Cent Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Buzzard, K:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, L7 635 Elizabeth St, Melbourne, Vic 3002, Australia
Box Hill Hosp, Dept Neurol, Melbourne, Vic, Australia
Monash Univ, Eastern Hlth Clin Sch, Dept Neurosci, Melbourne, Vic, Australia
Skibina, O:
Alfred Hosp, Dept Neurol, Melbourne, Vic, Australia
Box Hill Hosp, Dept Neurol, Melbourne, Vic, Australia
Foschi, M:
S Maria Croci Hosp Ravenna, Multiple Sclerosis Ctr, Dept Neurosci, Ravenna, Italy
Univ LAquila, Dept Biotechnol & Appl Clin Sci DISCAB, Laquila, Italy
Grand'Maison, F:
Neuro Rive Sud, Greenfield Pk, PQ, Canada
John, N:
Monash Hlth, Dept Neurol, Melbourne, VIC, Australia
Monash Univ, Sch Clin Sci, Dept Med, Clayton, Vic, Australia
Grammond, P:
CISSS Chaudiere Appalache, St Marie, PQ, Canada
Terzi, M:
Ondokuz Mayis Univ, Fac Med, Samsun, Turkiye
Prevost, J:
CSSS St Jerome, St Jerome, PQ, Canada
Barnett, M:
Brain & Mind Ctr, Sydney, NSW, Australia
Laureys, G:
Ghent Univ Hosp, Dept Neurol, Ghent, Belgium
Van Hijfte, L:
Ghent Univ Hosp, Dept Neurol, Ghent, Belgium
Sanchez-Menoyo, JL:
Hosp Galdakao Usansolo, Biocruces Bizkaia Hlth Res Inst, Dept Neurol, Galdakao, Spain
Blanco, Y:
Hosp Clin Barcelona, Ctr Neuroimmunol, Serv Neurol, Barcelona, Spain
Oh, J:
St Michaels Hosp, Toronto, ON, Canada
Mccombe, P:
Univ Queensland, Brisbane, Qld, Australia
Royal Brisbane & Womens Hosp, ,OLD, Brisbane, Australia
:
Hosp Germans Trias i Pujol, LUMN, Badalona, Spain
Soysal, A:
Bakirkoy Educ & Res Hosp Psychiat & Neurol Dis, Istanbul, Turkiye
Prat, A:
CHUM MS Ctr, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Duquette, P:
CHUM MS Ctr, Montreal, PQ, Canada
Univ Montreal, Montreal, PQ, Canada
Yamout, B:
Amer Univ Beirut, Med Ctr, Nehme & Therese Tohme Multiple Sclerosis Ctr, Beirut, Lebanon
Khoury, S:
Amer Univ Beirut, Med Ctr, Nehme & Therese Tohme Multiple Sclerosis Ctr, Beirut, Lebanon
van Pesch, V:
Clin Univ St Luc, Brussels, Belgium
Macdonell, R:
Austin Hlth, Melbourne, Vic, Australia
Sa, MJ:
Ctr Hosp Univ Sao Joao, Dept Neurol, Porto, Portugal
Univ Fernando Pessoa, Fac Hlth Sci, Porto, Portugal
Slee, M:
Flinders Univ Australia, Coll Med & Publ Hlth, Adelaide, Australia
Kuhle, J:
Univ Hosp Basel, MS Ctr, Neurol, Clin Res & Biomed & Biomed Engn, Basel, Switzerland
Univ Hosp Basel, Res Ctr Clin Neuroimmunol & Neurosci Basel RC2NB, Dept Head Spine & Neuromed, Biomed & Clin Res, Basel, Switzerland
Maimone, D:
UOC Neurol, ARNAS Garibaldi, Ctr Sclerosi Multipla, Catania, Italy
Spitaleri, DL:
AORN San Giuseppe Moscati, UO Cardiol UTIC, Avellino, Italy
Willekens, B:
Antwerp Univ Hosp, Dept Neurol, Edegem, Belgium
Univ Antwerp, Fac Med & Hlth Sci, Translat Neurosci Res Grp, Edegem, Belgium
Asmi, AA:
Sultan Qaboos Univ, Dept Ophthalmol, Coll Med & Hlth Sci, Sultan Qaboos Univ Hosp, Muscat, Oman
Tallantyre, E:
Univ Hosp Wales, Dept Neurol, Cardiff, Wales
Cardiff Univ, Div Psychol Med & Clin Neurosci, Cardiff, Wales
Robertson, NP:
Univ Hosp Wales, Dept Neurol, Cardiff, Wales
Cardiff Univ, Div Psychol Med & Clin Neurosci, Cardiff, Wales
Coles, A:
Univ Cambridge, Dept Clin Neurosci, Cambridge, England
Brown, JW:
Univ Cambridge, Dept Clin Neurosci, Cambridge, England
Kalincik, T:
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, L7 635 Elizabeth St, Melbourne, Vic 3002, Australia
Royal Melbourne Hosp, Neuroimmunol Ctr, Dept Neurol, Melbourne, Vic, Australia
Green Accepted, Green Published
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