Rituximab versus fingolimod after natalizumab in multiple sclerosis patients

Alping, Peter; Frisell, Thomas; Novakova, Lenka; Islam-Jakobsson, Protik; Salzer, Jonatan; Björck, Anna; Axelsson, Markus; Malmeström, Clas; Fink, Katharina; Lycke, Jan; Svenningsson, Anders; Piehl, Fredrik

doi:10.1002/ana.24651

Cited by 205 publications

(184 citation statements)

References 25 publications

(47 reference statements)

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“…A change in treatment strategy may increase the risk of recurring disease activity 35. More frequent MRI monitoring is therefore recommended in relation to changes in treatment, including when discontinuing DMT in patients with long follow‐up without new MRI lesions or clinical relapses.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society

et al. 2016

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Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.

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Section: Resultsmentioning

confidence: 99%

Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society

et al. 2016

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“…Treatment trials of rituximab (MabThera) by Swedish neurologists indicate that it has good efficacy for multiple sclerosis, and they have therefore prescribed the drug off-label (5,6).…”

Section: Off-label Prescribingmentioning

confidence: 99%

Skal legemiddelfirmaene bestemme hvilke studier som blir gjort?

Rogne¹

2017

Tidsskriftet

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“…Rituximab for relapsing MS Three Class II studies [36][37][38] and several large observational studies 39,40 Leflunomide for relapsing MS No published studies RCT of leflunomide vs teriflunomide…”

Section: Use Off-label Drugs As Dmts In Msmentioning

confidence: 99%

“…e10 A recent Swedish study comparing fingolimod vs rituximab in patients with relapsing MS who switched from natalizumab because of JC virus antibody positivity showed superiority of rituximab over fingolimod regarding both efficacy (relapses in 1.8% of rituximab-treated patients vs 17.6% on fingolimod; hazard ratio of 0.10) and safety (5.3% adverse event rate in rituximab patients vs 21.1% for fingolimod; hazard ratio of 0.25 in favor of rituximab). 39 At the Rocky Mountain MS Center at the University of Colorado, we infuse rituximab 1,000 mg once and repeat with 500 mg IV every 6 months thereafter (unless there is reconstitution of CD20 cells, in which case we use 1,000 mg every 6 months). While costs vary by location and may change over time, the current cost for 1,500 mg spread over 2 doses, including the infusions themselves, is approximately $20,000 at a Walgreen's infusion center in Colorado near our institution, well below the average wholesale prices, or wholesale acquisition costs of the standard DMTs.…”

Section: Develop Alternative Dosing Strategies For Food Andmentioning

confidence: 99%

Reducing costs while enhancing quality of care in MS

Kister

Corboy

2016

Neurology

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The rapid escalation in prices of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the past decade has resulted in a dramatic overall increase in the costs of MS-related care. In this article, we outline various approaches whereby neurologists can contribute to responsible cost containment while maintaining, and even enhancing, the quality of MS care. The premise of the article is that clinicians are uniquely positioned to introduce innovative management strategies that are both medically sound and cost-efficient. We describe our "top 5" recommendations, including strategies for customizing relapse treatment; developing alternative dosing schedules for Food and Drug Administration-approved MS DMTs; using off-label therapies for relapse suppression; and limiting the use of DMTs to those who clearly fulfill diagnostic criteria, and who might benefit from continued use over time. These suggestions are well-grounded in the literature and our personal experience, but are not always supported with rigorous Class I evidence as yet. We advocate for neurologists to take a greater role in shaping clinical research agendas and helping to establish cost-effective approaches on a firm empiric basis. Neurology ® 2016;87:1617-1622 GLOSSARY DMT 5 disease-modifying therapy; FDA 5 Food and Drug Administration; MS 5 multiple sclerosis; PML 5 progressive multifocal leukoencephalopathy; UBO 5 unidentified bright object.

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Rituximab versus fingolimod after natalizumab in multiple sclerosis patients

Cited by 205 publications

References 25 publications

Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society

Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society

Skal legemiddelfirmaene bestemme hvilke studier som blir gjort?

Reducing costs while enhancing quality of care in MS

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