Selecting Multiple Sclerosis Disease-Modifying Therapies After Natalizumab

Discontinuation of natalizumab has been associated with rebound disease in multiple sclerosis (MS). To better understand the sequencing of therapies after natalizumab and risk for disease activity, investigators used the MS BASE repository and retrospectively studied 1386 patients previously on natalizumab who had switched to dimethyl fumarate (DMF; n=138), fingolimod (n=823), or ocrelizumab (n=425) within 3 months of discontinuation.

Mean age was 41 years, median disease duration 11 years, and median washout 28 days. Propensity-weighted annualized relapse rates were 0.06 for ocrelizumab, 0.26 for fingolimod, and 0.27 for DMF. Compared with ocrelizumab, fingolimod had a 49% higher risk for disability accumulation after natalizumab. (Too few …