Switching from natalizumab to fingolimod in multiple sclerosis: a French prospective study



The researchers in this survey-based, observational multicentre cohort study investigated the efficacy and safety of switching from natalizumab to fingolimod in 333 patients with MS, after a mean of 31 natalizumab infusions.

The main outcome was the occurrence of MS relapses during the washout period (WP) or during the six-month follow-up period after starting fingolimod. They found that 27 per cent of patients relapsed during the WP. A washout period of less than three months was associated with a lower risk of relapse. Patients who stopped natalizumab due to poor tolerance or lack of efficacy also had a higher risk of relapse. Twenty per cent of patients had a relapse during the first six months of fingolimod treatment. Three per cent of patients stopped fingolimod due to efficacy, tolerance or compliance issues.

These results show that changing from natalizumab to fingolimod was associated with a risk of MS reactivation during the WP or shortly after starting fingolimod. Ideally the washout period should be shorter than three months.

Authors: Cohen M, Maillart E
Source: JAMA Neurol. 2014 Feb 24. doi: 10.1001/jamaneurol.2013.6240. [Epub ahead of print]
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