Lateral switch vs. escalation: 2 reports


Highlights of the 29th Congress of the European Committee for Treatment and Research in MS (ECTRIMS), Copenhagen, DK, October 2-5, 2013 – Two new analyses have examined the relative merits of maintaining treatment with a first-line injectable compared to escalating therapy. A US study retrospectively analysed a claims database to identify MS patients managed with a lateral switch from an interferon to glatiramer acetate, and those managed with treatment escalation from an interferon to fingolimod during a one-year period (October 2010 to September 2011) (Bergvall et al. ECTRIMS 2013; abstract P635).

The total sample was 606 patients. After switching, the proportion of patients with one or more relapses was 29.5% for those on glatiramer acetate compared to 16.7% for those on fingolimod; the duration on therapy was 282 days for the glatiramer acetate group and 307 days for the fingolimod group. The annualized relapse rate (ARR) was 0.55 for the glatiramer acetate cohort versus 0.27 for the fingolimod cohort. The probability of having a relapse was 61% lower for patients switching to fingolimod rather than to glatiramer acetate (p=0.0008), with fingolimod-treated patients experiencing 53% fewer relapses per year (p=0.0004).

Similar results were reported for the phase IIIb FIRST study, a single-arm open-label study evaluating outcomes of 2,417 RRMS patients four months after switching to fingolimod (Comi et al. ECTRIMS 2013; abstract P513). In the year prior to study entry, ARR was 1.13 in patients treated with glatiramer acetate, 1.01 in those on an interferon, and 1.26 in treatment-naïve patients. After four months of fingolimod, ARR was 0.51 in the prior glatiramer acetate group, 0.45 in the prior interferon group, and 0.22 in the previously untreated group. The relapse rate reduction with fingolimod was 55% for those previously treated with an injectable therapy, and 83% for previously untreated patients. The most common adverse effects after switching to fingolimod were nasopharyngitis and headache.

Guest Reviewer: Dr. Paul S. Giacomini, Associate Director, MS Clinic, Montreal Neurological Hospital and Institute, Assistant Professor, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec.

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