Comparative efficacy of first-line natalizumab vs IFN-beta or glatiramer acetate in relapsing MS

Tim Spelman*, Tomas Kalincik, Vilija Jokubaitis, Annie Zhang, Fabio Pellegrini, Heinz Wiendl, Shibeshih Belachew, Robert Hyde, Freek Verheul, Alessandra Lugaresi, Eva Havrdova, Dana Horakova, Pierre Grammond, Pierre Duquette, Alexandre Prat, Gerardo Iuliano, Murat Terzi, Guillermo Izquierdo, Raymond M. M. Hupperts, Cavit BozEugenio Pucci, Giorgio Giuliani, Patrizia Sola, Daniele L. A. Spitaleri, Jeannette Lechner-Scott, Roberto Bergamaschi, Francois Grand'Maison, Franco Granella, Ludwig Kappos, Maria Trojano, Helmut Butzkueven

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


We compared efficacy and treatment persistence in treatment-naive patients with relapsing-remitting multiple sclerosis (RRMS) initiating natalizumab compared with interferon-? (IFN-?)/glatiramer acetate (GA) therapies, using propensity score-matched cohorts from observational multiple sclerosis registries.The study population initiated IFN-?/GA in the MSBase Registry or natalizumab in the Tysabri Observational Program, had ?3 months of on-treatment follow-up, and had active RRMS, defined as ?1 gadolinium-enhancing lesion on cerebral MRI at baseline or ?1 relapse within the 12 months prior to baseline. Baseline demographics and disease characteristics were balanced between propensity-matched groups. Annualized relapse rate (ARR), time to first relapse, treatment persistence, and disability outcomes were compared between matched treatment arms in the total population (n = 366/group) and subgroups with higher baseline disease activity.First-line natalizumab was associated with a 68% relative reduction in ARR from a mean (SD) of 0.63 (0.92) on IFN-?/GA to 0.20 (0.63) (p [signed-rank] <0.0001), a 64% reduction in the rate of first relapse (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.28-0.47; p <0.001), and a 27% reduction in the rate of discontinuation (HR 0.73, 95% CI 0.58-0.93; p = 0.01), compared with first-line IFN-?/GA therapy. Confirmed disability progression and area under the Expanded Disability Status Scale-time curve analyses were not significant. Similar relapse and treatment persistence results were observed in each of the higher disease activity subgroups.This study provides Class IV evidence that first-line natalizumab for RRMS improves relapse and treatment persistence outcomes compared to first-line IFN-?/GA. This needs to be balanced against the risk of progressive multifocal leukoencephalopathy in natalizumab-treated patients.This study provides Class IV evidence that first-line natalizumab for RRMS improves relapse rates and treatment persistence outcomes compared to first-line IFN-?/GA.
Original languageEnglish
Pages (from-to)102-115
JournalNeurology: Clinical Practice
Issue number2
Publication statusPublished - Apr 2016

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