Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Roos Izanne, Sharmin Sifat, Malpas Charles, Ozakbas Serkan, Lechner-Scott Jeannette, Hodgkinson Suzanne, Alroughani Raed, Eichau Madueño Sara, Boz Cavit, van der Walt Anneke, Butzkueven Helmut, Buzzard Katherine, Skibina Olga, Foschi Matteo, Grand'Maison Francois, John Nevin, Grammond Pierre, Terzi Murat, Prévost Julie, Barnett Michael, Laureys Guy, Van Hijfte Liesbeth, Luis Sanchez-Menoyo Jose, Blanco Yolanda, Oh Jiwon, McCombe Pamela, Ramo Tello Cristina, Soysal Aysun, Prat Alexandre, Duquette Pierre, Yamout Bassem I, Khoury Samia, van Pesch Vincent, Macdonell Richard, José Sá Maria, Slee Mark, Kuhle Jens, Maimone Davide, Spitaleri Daniele LA, Willekens Barbara, Asmi Abdallah Al, Tallantyre Emma, Robertson Neil P, Coles Alasdair, L Brown J William, Kalincik Tomas
Аннотация
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.