Tomas Kalincik1, Vilija Jokubaitis2, Tim Spelman2, Dana Horakova3, Eva Havrdova3, Maria Trojano4, Jeannette Lechner-Scott5, Alessandra Lugaresi6, Alexandre Prat7, Marc Girard7, Pierre Duquette7, Pierre Grammond8, Claudio Solaro9, Francois Grand'Maison10, Raymond Hupperts11, Julie Prevost12, Patrizia Sola13, Diana Ferraro13, Murat Terzi14, Ernest Butler15, Mark Slee16, Allan Kermode17, Marzena Fabis-Pedrini18, Pamela McCombe19, Michael Barnett20, Cameron Shaw21, Suzanne Hodgkinson22, Helmut Butzkueven23. 1. CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia. 2. Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia. 3. Department of Neurology and Center of Clinical Neuroscience, General University Hospital and Charles University in Prague, Prague, Czech Republic. 4. Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy. 5. The University of Newcastle, Newcastle, NSW, Australia. 6. Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy/ Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy/IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. 7. Hôpital Notre-Dame, Montreal, QC, Canada/CHUM, Universite de Montreal, Montreal, QC, Canada. 8. CISSS de Chaudière-Appalache, Levis, QC, Canada. 9. Ospedale Padre Antero Micone, Genoa, Italy. 10. Clinique Neuro Rive-Sud, Greenfield Park, QC, Canada. 11. Zuyderland Ziekenhuis, Sittard, The Netherlands. 12. CSSS de Saint-Jérôme, Saint-Jerome, QC, Canada. 13. Nuovo Ospedale Civile Sant'Agostino-Estense, Modena, Italy. 14. Medical Faculty, 19 Mayis University, Samsun, Turkey. 15. Monash Medical Centre, Melbourne, VIC, Australia. 16. Flinders University, Adelaide, SA, Australia. 17. The Perron Institute, The University of Western Australia, Perth, WA, Australia/Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia. 18. The Perron Institute, The University of Western Australia, Perth, WA, Australia. 19. The University of Queensland, Brisbane, QLD, Australia/Royal Brisbane and Women's Hospital, Herston, QLD, Australia. 20. Brain and Mind Centre, Sydney, NSW, Australia. 21. Geelong Hospital, Geelong, VIC, Australia. 22. Liverpool Hospital, Sydney, NSW, Australia. 23. Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia.
Abstract
OBJECTIVE: This propensity score-matched analysis from MSBase compared the effectiveness of cladribine with interferon β, fingolimod or natalizumab. METHODS: We identified all patients with relapse-onset multiple sclerosis, exposure to the study therapies and ⩾1-year on-treatment follow-up from MSBase. Three pairwise propensity score-matched analyses compared treatment outcomes over 1 year. The outcomes were hazards of first relapse, disability accumulation and disability improvement events. Sensitivity analyses were completed. RESULTS: The cohorts consisted of 37 (cladribine), 1940 (interferon), 1892 (fingolimod) and 1410 patients (natalizumab). The probability of experiencing a relapse on cladribine was lower than on interferon ( p = 0.05), similar to fingolimod ( p = 0.31) and higher than on natalizumab ( p = 0.042). The probability of disability accumulation on cladribine was similar to interferon ( p = 0.37) and fingolimod ( p = 0.089) but greater than natalizumab ( p = 0.021). The probability of disability improvement was higher on cladribine than interferon ( p = 0.00017), fingolimod ( p = 0.0025) or natalizumab ( p = 0.00099). Sensitivity analyses largely confirmed the above results. CONCLUSION: Cladribine is an effective therapy for relapse-onset multiple sclerosis. Its effect on relapses is comparable to fingolimod and its effect on disability accrual is comparable to interferon β and fingolimod. Cladribine may potentially associate with superior recovery from disability relative to interferon, fingolimod and natalizumab.
OBJECTIVE: This propensity score-matched analysis from MSBase compared the effectiveness of cladribine with interferon β, fingolimod or natalizumab. METHODS: We identified all patients with relapse-onset multiple sclerosis, exposure to the study therapies and ⩾1-year on-treatment follow-up from MSBase. Three pairwise propensity score-matched analyses compared treatment outcomes over 1 year. The outcomes were hazards of first relapse, disability accumulation and disability improvement events. Sensitivity analyses were completed. RESULTS: The cohorts consisted of 37 (cladribine), 1940 (interferon), 1892 (fingolimod) and 1410 patients (natalizumab). The probability of experiencing a relapse on cladribine was lower than on interferon ( p = 0.05), similar to fingolimod ( p = 0.31) and higher than on natalizumab ( p = 0.042). The probability of disability accumulation on cladribine was similar to interferon ( p = 0.37) and fingolimod ( p = 0.089) but greater than natalizumab ( p = 0.021). The probability of disability improvement was higher on cladribine than interferon ( p = 0.00017), fingolimod ( p = 0.0025) or natalizumab ( p = 0.00099). Sensitivity analyses largely confirmed the above results. CONCLUSION:Cladribine is an effective therapy for relapse-onset multiple sclerosis. Its effect on relapses is comparable to fingolimod and its effect on disability accrual is comparable to interferon β and fingolimod. Cladribine may potentially associate with superior recovery from disability relative to interferon, fingolimod and natalizumab.
Authors: Zhifeng Mao; César Álvarez-Gonzalez; Stefania De Trane; Ozlem Yildiz; Christo Albor; Gabriel Doctor; Derek Soon; George Pepper; Benjamin P Turner; Monica Marta; Joela Mathews; Gavin Giovannoni; David Baker; Klaus Schmierer Journal: Mult Scler J Exp Transl Clin Date: 2018-06-26
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Authors: Nathaniel Lizak; Suzanne Hodgkinson; Ernest Butler; Jeannette Lechner-Scott; Mark Slee; Pamela Ann McCombe; Cameron Shaw; Olga Skibina; Steve Vucic; Neil Shuey; Michael H Barnett; John Parratt; Helmut Butzkueven; Dominic Jack; Jessica Fabris; Tomas Kalincik Journal: Mult Scler Date: 2020-06-12 Impact factor: 6.312
Authors: Steffen Pfeuffer; Leoni Rolfes; Jana Hackert; Konstanze Kleinschnitz; Tobias Ruck; Heinz Wiendl; Luisa Klotz; Christoph Kleinschnitz; Sven G Meuth; Refik Pul Journal: Mult Scler Date: 2021-05-12 Impact factor: 6.312