%0 Journal Article
%T Safety and effectiveness of disease-modifying therapies after switching from natalizumab.
%A Zeineddine M
%A Al-Roughani R
%A Farouk Ahmed S
%A Khoury S
%A El-Ayoubi N
%A Al-Mahdawi A
%A Al-Khabouri J
%A Al-Asmi A
%A Chentouf A
%A Inshasi J
%A Gouider R
%A Mrabet S
%A Shalaby N
%A Massouh J
%A Mohamed Ramzy Hasan Mohamed F
%A Al-Hajje A
%A Salameh P
%A Dimassi H
%A Boumediene F
%A Yamout B
%J Mult Scler
%V 30
%N 8
%D 2024 Jul 26
%M 39054846
%F 5.855
%R 10.1177/13524585241261565
%X UNASSIGNED: One strategy to mitigate progressive multifocal leukoencephalopathy (PML) risk is to switch to other highly effective disease-modifying therapies (DMTs). However, the optimal switch DMT following natalizumab (NTZ) discontinuation is yet to be determined.
UNASSIGNED: The objective of the study is to determine the most effective and tolerable DMTs to switch to following NTZ discontinuation due to John Cunningham virus (JCV) antibody positivity.
UNASSIGNED: This is a multicenter observational cohort study that included all stable relapsing-remitting multiple sclerosis (MS) patients who were treated with NTZ for at least 6 months before switching therapy due to JCV antibody positivity.
UNASSIGNED: Of 321 patients, 255 switched from NTZ to rituximab/ocrelizumab, 52 to fingolimod, and 14 to alemtuzumab, with higher annualized relapse rate (ARR) in fingolimod switchers (0.193) compared with rituximab/ocrelizumab or alemtuzumab (0.028 and 0.032, respectively). Fingolimod switchers also had increased disability progression (p = 0.014) and a higher proportion developed magnetic resonance imaging (MRI) lesions compared with rituximab/ocrelizumab (62.9% vs. 13.0%, p < 0.001, and 66.6% vs. 24.0%, p < 0.001, respectively). Mean drug survival favored rituximab/ocrelizumab or alemtuzumab over fingolimod (p < 0.001).
UNASSIGNED: Our study shows superior effectiveness of rituximab/ocrelizumab and alemtuzumab compared with fingolimod in stable patients switching from NTZ due to JC virus antibody positivity.