title: A longitudinal real-life comparison study of natalizumab and fingolimod.
abstract: BACKGROUND
  Different retrospective studies compared natalizumab and fingolimod in relapsing-remitting multiple sclerosis (RRMS), with conflicting results. We aimed to explore the prescriptive attitude and the clinical outcome of the two therapies.
  
  
  METHODS
  We retrospectively included all RRMS patients treated with natalizumab (n=101) or fingolimod (n=78) as their first second-line therapy with at least 24-month follow-up. Demographic and clinical features were recorded to calculate the propensity score (PS). Outcomes of interest were annualized relapse rate (ARR), risk of relapse, and change in the EDSS RESULTS: At baseline, natalizumab patients were younger and had a shorter disease duration, a higher number of relapse in 1 year (1yR) and 2 years (2yR) and overall (ARR-PT) pretherapy, compared to fingolimod patients. On therapy, the proportion of relapsing patients and the mean RR were similar in the two groups. However, the change in the ARR was higher in natalizumab than in fingolimod group (P<.002), but, using PS as a covariate, it was comparable (P=.960). Similarly, the change in EDSS was significantly different for the two groups (P<.004), but not after adjusting for the PS (P=.321).
  
  
  CONCLUSIONS
  We observed a comparable efficacy on ARR reduction and on EDSS progression with natalizumab and fingolimod correcting through PS, suggesting that the efficacy difference observed before correction might derive from the clinical attitude in prescribing natalizumab in more active MS patients in real life.
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lanzillo
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Carotenuto
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Moccia
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Saccà
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: C V
authors.initials: CV
authors.lastname: Russo
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Massarelli
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: De Rosa
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Centre, Federico II University, Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Brescia Morra
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D000069442:Natalizumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents; D000069442:Natalizumab; D000068876:Fingolimod Hydrochloride
keywords: 
  DMT
  ; fingolimod; multiple sclerosis; natalizumab; propensity score