Fingolimod after Natalizumab and the risk of short-term relapse

Vilija G Jokubaitis, Vivien Li, Tomas Kalincik, Guillermo Izquierdo, Suzanne J Hodgkinson, Raed A Alroughani, Jeannette Lechner-Scott, Alessandra Lugaresi, Pierre Pascal Duquette, Marc Girard, Michael Barnett, Francois Grand'Maison, Maria Trojano, Mark Slee, Giorgio Giuliani, Cameron Shaw, Cavit Boz, Daniele La Spitaleri, Freek Verheul, Jodi HaartsenDanny Liew, Helmut Butzkueven, on behalf of the MSBase Study Group

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110 Citations (Scopus)


To determine early risk of relapse after switch from natalizumab to fingolimod; to compare the switch experience to that in patients switching from interferon-?/glatiramer acetate (IFN-?/GA) and those previously treatment naive; and to determine predictors of time to first relapse on fingolimod. Methods: Data were obtained from the MSBase Registry. Relapse rates (RRs) for each patient group were compared using adjusted negative binomial regression. Survival analyses coupled with adjusted Cox regression were used to model predictors of time to first relapse on fingolimod. Results: A total of 536 patients (natalizumab-fingolimod [n 5 89]; IFN-?/GA-fingolimod [n 5 350]; naive-fingolimod [n 5 97]) were followed up for a median 10 months. In the natalizumab-fingolimod group, there was a small increase in RR on fingolimod (annualized RR [ARR] 0.38) relative to natalizumab (ARR 0.26; p 5 0.002). RRs were generally low across all patient groups in the first 9 months on fingolimod (RR 0.001-0.13). However, 30 of patients with disease activity on natalizumab relapsed within the first 6 months on fingolimod. Independent predictors of time to first relapse on fingolimod were the number of relapses in the prior 6 months (hazard ratio [HR] 1.59 per relapse; p 5 0.002) and a gap in treatment of 2-4 months compared to no gap (HR 2.10; p 5 0.041). Conclusions: RRs after switch to fingolimod were lowin all patient groups. The strongest predictor of relapse on fingolimod was prior relapse activity. Based on our data, we recommend a maximum 2-month treatment gap for switches to fingolimod to decrease the hazard of relapse. Classification of evidence: This study provides Class IV evidence that RRs are not higher in patients with multiple sclerosis switching to fingolimod from natalizumab compared to those patients switching to fingolimod from other therapies.
Original languageEnglish
Pages (from-to)1204-1211
Number of pages8
Issue number14
Publication statusPublished - 2014

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