Rituximab versus natalizumab, fingolimod, and dimethyl fumarate in multiple sclerosis treatment

Abstract

Introduction Limited comparative effectiveness data for rituximab (RTX) versus natalizumab (NTZ), fingolimod (FTY), and dimethyl fumarate (DMF) for the treatment of multiple sclerosis (MS) exist. Methods Clinician‐reported data on patients prescribed RTX, NTZ, FTY, or DMF for the treatment of MS at the Rocky Mountain MS Center at the University of Colorado were retrospectively collected. Outcomes included a composite effectiveness measure consisting of clinical relapse, contrast‐enhancing lesions, and/or new T2 lesions, individual effectiveness outcomes, and discontinuation. Logistic regression was used on patients matched by propensity scores and using average treatment effect on treated doubly robust weighting estimator. Results A total of 182, 451, 271, and 342 patients initiated RTX, NTZ, FTY, and DMF and were followed for 2 years. Before and after adjustment, the odds of experiencing disease activity was significantly higher for FTY [adjusted OR (aOR) = 3.17 (95% CI: 1.81–5.55), P < 0.001].and DMF [aOR = 2.68 (95% CI:1.67–4.29), P < 0.001], and similar for NTZ [aOR = 1.36 (95% CI:0.83–2.23), P = 0.216] versus RTX. When examining months 6–24, NTZ demonstrated higher odds of disease activity compared to RTX [aOR = 2.21 (95% CI: 1.20–4.06), P = 0.007]. Similar odds of discontinuation were seen between NTZ and RTX [aOR = 1.39 (95% CI: 0.88–2.20), P = 0.157]; however, FTY [aOR = 2.02 (95% CI: 1.24–3.30), P = 0.005] and DMF [aOR = 3.27 (95% CI: 2.15–4.97), P < 0.001] had greater odds of discontinuation than RTX. Interpretation RTX demonstrated superior effectiveness and discontinuation outcomes compared to FTY and DMF. Although RTX demonstrated similar effectiveness and discontinuation compared to NTZ, RTX had superior effectiveness during months 6–24 and fewer discontinuations when excluding discontinuations due to insurance issues. Results suggest superiority of RTX in reducing disease activity and maintaining long‐term treatment in a real‐world MS cohort.

Real-World Comparative Cost-Effectiveness Analysis of Different Classes of Disease-Modifying Therapies for Relapsing-Remitting Multiple Sclerosis in Saudi Arabia

“…In addition, the odds of disability progression and MRI lesions were 79.9% lower among patients on MABs compared to Rebif ® and orally administered agents. This is consistent with previously published studies that found rituximab and natalizumab to be superior in comparison to oral DMTs and IFN-based therapies in the management of RRMS [ 15 , 16 , 17 , 18 ]. However, this comes at a higher cost when compared to IFN-based therapies or oral DMTs.…”

Comparative effectiveness of natalizumab versus ocrelizumab in multiple sclerosis: a real-world propensity score–matched study

“…38 Similar trends concerning natalizumab and rituximab were observed in other retrospective studies. 39,40 These results fit well with our data on relapse risk.…”

Comparative Efficacy of Disease-Modifying Treatments for Relapsing Multiple Sclerosis—Variations in Real-World Experience

“…ARR was 0.067 for patients transitioning to rituximab after a “second-line” DMT and 0.016 for treatment-naive patients (strikingly similar to the ARR reported for treatment-naive patients who initiated rituximab in the phase 3 Rituximab vs Fumarate in Newly Diagnosed Multiple Sclerosis [RIFUND-MS] RCT) . Additionally, in our center’s experience, ARR was 0.027 for 113 rituximab-treated patients with relapsing-remitting MS over 24 months …”