RT Journal Article
T1 Treatment effectiveness of alemtuzumab compared with natalizumab, fingolimod, and interferon beta in relapsing-remitting multiple sclerosis: a cohort study.
A1 Kalincik, Tomas
A1 Brown, J William L
A1 Robertson, Neil
A1 Willis, Mark
A1 Scolding, Neil
A1 Rice, Claire M
A1 Wilkins, Alastair
A1 Pearson, Owen
A1 Ziemssen, Tjalf
A1 Hutchinson, Michael
A1 McGuigan, Christopher
A1 Jokubaitis, Vilija
A1 Spelman, Tim
A1 Horakova, Dana
A1 Havrdova, Eva
A1 Trojano, Maria
A1 Izquierdo, Guillermo
A1 Lugaresi, Alessandra
A1 Prat, Alexandre
A1 Girard, Marc
A1 Duquette, Pierre
A1 Grammond, Pierre
A1 Alroughani, Raed
A1 Pucci, Eugenio
A1 Sola, Patrizia
A1 Hupperts, Raymond
A1 Lechner-Scott, Jeannette
A1 Terzi, Murat
A1 Van Pesch, Vincent
A1 Rozsa, Csilla
A1 Grand'Maison, François
A1 Boz, Cavit
A1 Granella, Franco
A1 Slee, Mark
A1 Spitaleri, Daniele
A1 Olascoaga, Javier
A1 Bergamaschi, Roberto
A1 Verheul, Freek
A1 Vucic, Steve
A1 McCombe, Pamela
A1 Hodgkinson, Suzanne
A1 Sanchez-Menoyo, Jose Luis
A1 Ampapa, Radek
A1 Simo, Magdolna
A1 Csepany, Tunde
A1 Ramo, Cristina
A1 Cristiano, Edgardo
A1 Barnett, Michael
A1 Butzkueven, Helmut
A1 Coles, Alasdair
A1 MSBase Study Group, 
AB Alemtuzumab, an anti-CD52 antibody, is proven to be more efficacious than interferon beta-1a in the treatment of relapsing-remitting multiple sclerosis, but its efficacy relative to more potent immunotherapies is unknown. We compared the effectiveness of alemtuzumab with natalizumab, fingolimod, and interferon beta in patients with relapsing-remitting multiple sclerosis treated for up to 5 years. In this international cohort study, we used data from propensity-matched patients with relapsing-remitting multiple sclerosis from the MSBase and six other cohorts. Longitudinal clinical data were obtained from 71 MSBase centres in 21 countries and from six non-MSBase centres in the UK and Germany between Nov 1, 2015, and June 30, 2016. Key inclusion criteria were a diagnosis of definite relapsing-remitting multiple sclerosis, exposure to one of the study therapies (alemtuzumab, interferon beta, fingolimod, or natalizumab), age 65 years or younger, Expanded Disability Status Scale (EDSS) score 6·5 or lower, and no more than 10 years since the first multiple sclerosis symptom. The primary endpoint was annualised relapse rate. The secondary endpoints were cumulative hazards of relapses, disability accumulation, and disability improvement events. We compared relapse rates with negative binomial models, and estimated cumulative hazards with conditional proportional hazards models. Patients were treated between Aug 1, 1994, and June 30, 2016. The cohorts consisted of 189 patients given alemtuzumab, 2155 patients given interferon beta, 828 patients given fingolimod, and 1160 patients given natalizumab. Alemtuzumab was associated with a lower annualised relapse rate than interferon beta (0·19 [95% CI 0·14-0·23] vs 0·53 [0·46-0·61], p Alemtuzumab and natalizumab seem to have similar effects on annualised relapse rates in relapsing-remitting multiple sclerosis. Alemtuzumab seems superior to fingolimod and interferon beta in mitigating relapse activity. Natalizumab seems superior to alemtuzumab in enabling recovery from disability. Both natalizumab and alemtuzumab seem highly effective and viable immunotherapies for multiple sclerosis. Treatment decisions between alemtuzumab and natalizumab should be primarily governed by their safety profiles. National Health and Medical Research Council, and the University of Melbourne.
YR 2017
FD 2017-02-11
LK http://hdl.handle.net/10668/10872
UL http://hdl.handle.net/10668/10872
LA en
DS RISalud
RD Apr 8, 2025