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Switching multiple sclerosis patients with breakthrough disease to second-line therapy
Tamara Castillo-Trivino1, Ellen M Mowry, Alberto Gajofatto
1Multiple Sclerosis Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
Plos One
|February 10, 2011
Summary
Switching multiple sclerosis patients with breakthrough disease to natalizumab or immunosuppressants significantly reduced relapse rates. This study highlights effective treatment options for managing active relapsing MS.
Area of Science:
- Neurology
- Immunology
- Clinical Trials
Background:
- Multiple sclerosis (MS) patients experiencing breakthrough disease on immunomodulatory drugs often transition to natalizumab or immunosuppressants.
- The efficacy of natalizumab monotherapy in this specific patient group remains largely uncharacterized.
Purpose of the Study:
- To evaluate the effectiveness of switching to natalizumab or immunosuppressants in multiple sclerosis patients with breakthrough disease.
- To compare relapse rates before and after treatment modification in different patient groups.
Main Methods:
- An open-label retrospective cohort study involving 993 patients at the University of California San Francisco MS Center.
- Analysis of 95 patients with breakthrough disease: 60 switched to natalizumab, 22 to immunosuppressants, and 13 did not switch.
- Poisson regression was used to compare relapse rates, adjusting for potential confounders.
Main Results:
- Relapse rates decreased significantly: 70% in natalizumab switchers and 77% in immunosuppressant switchers.
- No significant decrease in relapse rate was observed in non-switchers (6% reduction).
- Compared to non-switchers, natalizumab switchers showed a 68% reduction in relapse rate, and immunosuppressant switchers showed a 76% reduction.
Conclusions:
- Switching to natalizumab or immunosuppressants is effective for reducing clinical activity in relapsing MS patients with breakthrough disease.
- Further evaluation of the risk-benefit ratio and efficacy is warranted through randomized clinical trials and prospective studies.
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