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Ann Clin Transl Neurol. 2018 Dec 9;6(2):252-262. doi: 10.1002/acn3.700. eCollection 2019 Feb.

Natalizumab versus fingolimod and dimethyl fumarate in multiple sclerosis treatment.

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Division of Neuroimmunology Department of Neurology Rocky Mountain Multiple Sclerosis Center at the University of Colorado Aurora Colorado.
Skaggs School of Pharmacy and Pharmaceutical Sciences University of Colorado Aurora Colorado.



To compare 2-year effectiveness and discontinuation of natalizumab (NTZ) versus fingolimod (FTY) and dimethyl fumarate (DMF) in the treatment of multiple sclerosis (MS).


Patients prescribed NTZ, FTY, or DMF at the Rocky Mountain MS Center at University of Colorado were identified. Clinician-reported data were retrospectively collected. Outcomes include a composite effectiveness measure consisting of new T2 lesion, gadolinium-enhancing lesion, and/or clinical relapse, individual effectiveness outcomes and discontinuation over 2 years. Logistic regression was used for data analysis on patients matched by propensity scores and using ATT doubly robust weighting estimator.


A total of 451, 271, and 342 patients were evaluated on NTZ, FTY, and DMF over 2 years, respectively. Patients had a mean age of 39.8 (NTZ), 42.5(FTY), and 45.8 (DMF) years; were predominantly female (76.7% NTZ; 72.0% FTY; 69.6% DMF); and had a mean MS disease duration of 11-12 years for all groups. At ≤24 months, 22.2%, 34.7%, and 33.6% experienced a new T2 lesion, gadolinium-enhancing lesion, and/or clinical relapse on NTZ, FTY, and DMF, respectively. Using ATT doubly robust weighting estimator, FTY versus NTZ and DMF versus NTZ had an odds ratio of 2.00 (95%CI:[1.41-2.85], P < 0.001) and 2.38 [95% CI: 1.68-3.37], P < 0.001) respectively, for experiencing a new T2 lesion, gadolinium enhancing lesion, and/or clinical relapse. At ≤24 months, 32.6%, 34.3%, and 47.1% discontinued NTZ, FTY, and DMF, respectively. The majority of discontinuations were due to becoming JCV positive(12.6%) for NTZ and due to adverse events for both FTY(17%) and DMF(24.0%).


NTZ appears to be more effective and tolerable than FTY and DMF.

Conflict of interest statement

Brandi L. Vollmer reports no disclosures. Dr. Kavita V. Nair receives grants from Novartis, Genentech, Biogen and consulting fees from Biogen, Sanofi‐Genzyme and Astellas. Dr. Stefan Sillau reports no disclosures. Dr. John R. Corboy recieves research support from PCORI, NMSS, Biogen, Novartis and Med Day, has received honorarium for speaking from the Rocky Mountain MS Center and PRIME CME, and has received compensation as editor of Neurology Clinical Practice. Dr. Timothy Vollmer has received compensation for activities such as advisory boards, lectures and consultancy with the following companies and organizations: Academic CME; Alcimed; Anthem Blue Cross; Genentech/Roche; Biogen IDEC; Novartis; CellGene; Seono; Epigene; Rocky Mountain MS Center; GLG Consulting; Ohio Health; TG Therapeutics; Topaz Therapeutics; Dleara Lawyers; and Teva Neuroscience; Biogen Australia & New Zealand. He received research support from the following: Teva Neuroscience; NIH/NINDS; Rocky Mountain MS Center; Biogen; Actelion; Roche/Genentech; UT Southwestern; F. Hoffman‐La Roche, Ltd and TG Therapeutics, Inc. Dr. Enrique Alvarez grants/studies from Genzyme, Biogen, Rocky Mountain MS Center, Novartis, Acorda and consulting for Genzyme, Genentech, Novartis, Acorda and Biogen.

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