■克拉屈滨与其他有效的多发性硬化症(MS)免疫疗法之间的比较缺乏。
■为了比较克拉屈滨与芬戈莫德的疗效,那他珠单抗,奥克瑞珠单抗和阿仑珠单抗治疗复发缓解型MS。
■接受克拉屈滨治疗的复发缓解型MS患者,芬戈莫德,那他珠单抗,在全球MSBase队列和另外两个英国中心中发现了奥克瑞珠单抗或阿仑珠单抗.患者被跟踪6/12,并有3个人残疾评估。使用倾向评分对患者进行匹配。四个成对分析比较了年复发率(ARR)和残疾结果。
■符合条件的队列包括853(芬戈莫德),464(那他珠单抗),1131(奥克雷珠单抗),123例(阿仑单抗)或493例(克拉屈滨)患者。克拉屈滨的ARR低于芬戈莫德(0.07vs.0.12,p=0.006),ARR高于那他珠单抗(0.10vs.0.06,p=0.03),奥克瑞珠单抗(0.09vs.0.05,p=0.008)和阿仑珠单抗(0.17vs.0.04,p<0.001)。与克拉屈滨相比,使用芬戈莫德(风险比(HR)1.08,95%置信区间(CI)0.47-2.47)或阿仑珠单抗(HR0.73,95%CI0.26-2.07)治疗的患者的残疾恶化风险没有差异,但在接受那他珠单抗(HR0.35,95%CI0.13-0.94)和奥克瑞珠单抗(HR0.45,95%CI0.26-0.78)治疗的患者中更低.没有证据表明残疾改善有差异。
■克拉屈滨是一种有效的治疗方法,可以看作是芬戈莫德的有效性提高,但效果不如最有效的静脉MS疗法。
UNASSIGNED: Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking.
UNASSIGNED: To compare the effectiveness of cladribine against fingolimod,
natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.