Switch to Fingolimod is More Effective for Active MS

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with multiple sclerosis (MS) that relapses while they are taking an injectable disease-modifying drug fare better when they switch to fingolimod, according to results from the MSBase Study Group.

"Patients who experience break-through MS activity, i.e. relapses or progression of disability while treated with interferon beta or glatiramer acetate, increase their chance of reaching a better control of their disease by escalating therapy to fingolimod rather than switching to another injectable preparation," Dr. Tomas Kalincik, from Royal Melbourne Hospital, Parkville, Victoria, Australia, told Reuters Health by email.

Earlier trials have shown fingolimod to be effective for MS, but they did not address the relative effectiveness of switching from interferon beta/glatiramer acetate to fingolimod versus switching between interferon beta/glatiramer acetate preparations in patients with on-treatment relapses.

Dr. Kalincik and colleagues used propensity-based matching to investigate which strategy was better.

After propensity score matching, 148 patients in the fingolimod group were matched to 379 patients in the interferon beta/glatiramer acetate group.

Patients switched to fingolimod were 26% less likely to have on-treatment relapse than patients switched to another interferon beta/glatiramer acetate preparation (annualized relapse rate, 0.31 vs 0.42; p=0.04), according to the February 9 JAMA Neurology online report.

Compared with the interferon beta/glatiramer acetate group, the fingolimod group was significantly less likely to have confirmed disability progression and significantly more likely to have disability regression.

The rate of treatment discontinuation at 24 months was significantly lower with fingolimod (17.5%) than with interferon beta/glatiramer acetate (26.8%; p=0.04).

"At the present time, the aim of disease modifying therapy in multiple sclerosis can be summarized as 'no evidence of disease activity,'" Dr. Kalincik said. "Given the increasing availability of disease modifying agents, escalation of therapy should always be considered in patients treated with injectable immunomodulators and with recent evidence of clinical activity."

"We did not compare safety profiles of the two evaluated switching strategies," Dr. Kalincik said. "While our study supported treatment escalation over treatment switch from the perspective of treatment efficacy, safety profiles of the available treatment options should always be reviewed carefully between patients and their physicians."

Dr. Olaf Stüve, from the University of Texas Southwestern Medical Center, Dallas, and Dr. Diego Centonze, from Tor Vergata University and Hospital, Rome, Italy, wrote an editorial on the study. Dr. Centonze told Reuters Health by email, "It is a further piece of evidence in favor of the concept that escalation to fingolimod or natalizumab appears to be a better option than switching to another injectable (lateral switching) in patients with suboptimal disease control."

He cited "safety concerns, lack of experience with second-line agents, and costs" as other factors that should go into the decision as to how to respond to the first signs of disease return.

Dr. Centonze cautioned that "final results should come from randomized, head-to-head trials, and this report is not."

Dr. Hans-Peter Hartung, from Heinrich-Heine University, Duesseldorf, Germany, has published numerous reports of MS treatments. He told Reuters Health by email, "If continued disease activity requires a change in disease-modifying drug (DMD), I would go straight to fingolimod."

This research was supported by Novartis Pharma, Multiple Sclerosis Research Australia, National Health and Medical Research Council, Centre For Research Excellence, and MSBase Foundation.

SOURCE: https://bit.ly/1AjOIvs and https://bit.ly/1zd5uq8

JAMA Neurol 2015.

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