Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis-Reference-Cited by-同舟云学术

Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis

Published:2024-08 Issue:9 Volume:30 Page:1163-1175
ISSN:1352-4585
Container-title:Multiple Sclerosis Journal
language:en
Short-container-title:Mult Scler

Author:

Roos Izanne¹^ORCID,Sharmin Sifat¹,Malpas Charles¹,Ozakbas Serkan²,Lechner-Scott Jeannette³,Hodgkinson Suzanne⁴,Alroughani Raed⁵,Eichau Madueño Sara⁶^ORCID,Boz Cavit⁷,van der Walt Anneke⁸^ORCID,Butzkueven Helmut⁸,Buzzard Katherine⁹¹⁰¹¹,Skibina Olga¹²¹⁰¹¹,Foschi Matteo¹³¹⁴,Grand’Maison Francois¹⁵,John Nevin¹⁶¹⁷^ORCID,Grammond Pierre¹⁸,Terzi Murat¹⁹,Prévost Julie²⁰,Barnett Michael²¹^ORCID,Laureys Guy²²,Van Hijfte Liesbeth²²,Luis Sanchez-Menoyo Jose²³,Blanco Yolanda²⁴,Oh Jiwon²⁵^ORCID,McCombe Pamela²⁶,Ramo Tello Cristina²⁷,Soysal Aysun²⁸,Prat Alexandre²⁹,Duquette Pierre²⁹^ORCID,Yamout Bassem I³⁰,Khoury Samia³⁰,van Pesch Vincent³¹,Macdonell Richard³²,José Sá Maria³³,Slee Mark³⁴,Kuhle Jens³⁵,Maimone Davide³⁶,Spitaleri Daniele LA³⁷,Willekens Barbara³⁸³⁹,Asmi Abdallah Al⁴⁰,Tallantyre Emma⁴¹^ORCID,Robertson Neil P⁴¹,Coles Alasdair⁴²,L Brown J William⁴²^ORCID,Kalincik Tomas¹^ORCID

Affiliation:

1. CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia

2. Dokuz Eylul University, Konak, Izmir, Turkey

3. Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia/John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia

4. Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, NSW, Australia

5. Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait

6. Hospital Universitario Virgen Macarena, Sevilla, Spain

7. Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

8. Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia

9. Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia

10. Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia

11. Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia

12. Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia

13. Department of Neuroscience, Multiple Sclerosis Center, S. Maria delle Croci Hospital of Ravenna, Ravenna, Italy

14. Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, L’Aquila, Italy

15. Neuro Rive-Sud, Greenfield Park, QC, Canada

16. Department of Neurology, Monash Health, Melbourne, VIC, Australia

17. Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia

18. CISSS de Chaudière-Appalache, Sainte-Marie, QC, Canada

19. Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

20. CSSS de Saint-Jérôme, Saint-Jerome, QC, Canada

21. Brain and Mind Centre, Sydney, NSW, Australia

22. Department of Neurology, Ghent University Hospital, Ghent, Belgium

23. Department of Neurology, Hospital de Galdakao-Usansolo, Biocruces-Bizkaia Health Research Institute, Galdakao, Spain

24. Center of Neuroimmunology, Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain

25. St. Michael’s Hospital, Toronto, ON, Canada

26. The University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women’s Hospital, Brisbane, OLD, Australia

27. Hospital Germans Trias i Pujol, Badalona, Spain

28. Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey

29. CHUM MS Center and Universite de Montreal, Montreal, QC, Canada

30. Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon

31. Cliniques Universitaires Saint-Luc, Brussels, Belgium

32. Austin Health, Melbourne, VIC, Australia

33. Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal

34. College of Medicine and Public Health, Flinders University, Adelaide, Australia

35. Neurology, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland

36. Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi, Catania, Italy

37. Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy

38. Department of Neurology, Antwerp University Hospital, Edegem, Belgium

39. Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium

40. College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman

41. Department of Neurology, University Hospital of Wales; Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK

42. Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK

Abstract

Background: Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking. Objectives: To compare the effectiveness of cladribine against fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS. Methods: Patients with relapsing-remitting MS treated with cladribine, fingolimod, natalizumab, ocrelizumab or alemtuzumab were identified in the global MSBase cohort and two additional UK centres. Patients were followed for ⩾6/12 and had ⩾3 in-person disability assessments. Patients were matched using propensity score. Four pairwise analyses compared annualised relapse rates (ARRs) and disability outcomes. Results: The eligible cohorts consisted of 853 (fingolimod), 464 (natalizumab), 1131 (ocrelizumab), 123 (alemtuzumab) or 493 (cladribine) patients. Cladribine was associated with a lower ARR than fingolimod (0.07 vs. 0.12, p = 0.006) and a higher ARR than natalizumab (0.10 vs. 0.06, p = 0.03), ocrelizumab (0.09 vs. 0.05, p = 0.008) and alemtuzumab (0.17 vs. 0.04, p < 0.001). Compared to cladribine, the risk of disability worsening did not differ in patients treated with fingolimod (hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.47–2.47) or alemtuzumab (HR 0.73, 95% CI 0.26–2.07), but was lower for patients treated with natalizumab (HR 0.35, 95% CI 0.13–0.94) and ocrelizumab (HR 0.45, 95% CI 0.26–0.78). There was no evidence for a difference in disability improvement. Conclusion: Cladribine is an effective therapy that can be viewed as a step up in effectiveness from fingolimod, but is less effective than the most potent intravenous MS therapies.

Funder

National Health and Medical Research Council

Multiple Sclerosis Australia

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/13524585241267211

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