title: Natalizumab versus fingolimod in patients with relapsing-remitting multiple sclerosis non-responding to first-line injectable therapies.
abstract: Natalizumab and fingolimod have not been compared in controlled trials but only in observational studies, with inconclusive results.
  
  
  
  The objective of this study is to compare the effect of natalizumab and fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RRMS).
  
  
  
  We included all consecutive RRMS patients switched from first-line agents (glatiramer acetate/interferons) to natalizumab or fingolimod, with a follow-up of 24 months. Data of relapses, Expanded Disability Status Scale score and brain magnetic resonance imaging (MRI) scans were collected. We used propensity score (PS) matching and intention-to-treat analysis.
  
  
  
  We retained 102 patients in each cohort after PS matching, with similar baseline characteristics. More patients discontinued natalizumab compared to fingolimod (33% vs 11%, p < 0.001), mainly for progressive multifocal leukoencephalopathy (PML) concern. No serious adverse events occurred in the two cohorts. Compared to fingolimod, the natalizumab group presented a higher percentage of relapse-free patients (66% vs 80%, p = 0.015), a higher percentage of disability-improved patients (6% vs 15%, p = 0.033), a lower percentage of MRI-active patients (38% vs 14%, p = 0.001) and a higher percentage of patients with no evidence of disease activity (NEDA-3; 44% vs 70%, p < 0.001) after 2 years of follow-up. Disability worsening was not statistically different in the two groups.
  
  
  
  Natalizumab is superior to fingolimod in RRMS patients non-responding to first-line agents.
authors.affiliation: Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital, Gallarate, Italy damianobaroncini@gmail.com.
authors.forename: Damiano
authors.initials: D
authors.lastname: Baroncini
authors.affiliation: Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital, Gallarate, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ghezzi
authors.affiliation: Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital, Gallarate, Italy.
authors.forename: Pietro O
authors.initials: PO
authors.lastname: Annovazzi
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Colombo
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Martinelli
authors.affiliation: Department of Neuroradiology, Sant'Antonio Abate Hospital, Gallarate, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Minonzio
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Moiola
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy.
authors.forename: Mariaemma
authors.initials: M
authors.lastname: Rodegher
authors.affiliation: Multiple Sclerosis Study Center, Sant'Antonio Abate Hospital, Gallarate, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Zaffaroni
authors.affiliation: Department of Neurology, San Raffaele Hospital, Milan, Italy/Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Comi
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D000069340:Deprescriptions; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000627:therapeutic use*; D000068717:Glatiramer Acetate / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007372:Interferons / Q000627:therapeutic use; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000069442:Natalizumab / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D000068717:Glatiramer Acetate; D007372:Interferons; D000068876:Fingolimod Hydrochloride
keywords: Multiple sclerosis; comparison; fingolimod; natalizumab; second line