A retrospective analysis found that natalizumab is more effective than fingolimod, in preventing relapses in patients with relapsing-remitting multiple sclerosis (RRMS). Natalizumab is a monoclonal antibody targeting VLA4 and fingolimod is a sphingosine-1 receptor antagonist; both are FDA-approved for the treatment of RRMS.

The analysis was conducted by researchers in France, who collected data from 27 multiple sclerosis centers. Selection criteria included Individuals with RRMS between the ages 18 and 65 who had an Expanded Disability Status Scale (EDSS) score ranging between 0 to 5.5 and a brain MRI performed within the year before starting treatment. These parameters captured 629 patients in total; 326 treated with natalizumab and 303 treated with fingolimod.

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The primary endpoint was patient relapse in the first year, and a secondary endpoint was patient relapse in the second year. Compared to fingolimod-treated patients, the proportion of patients with at least one relapse within the first and second year was lower in patients treated with natalizumab (first year: 30.4% vs. 21.1%; second year: 41.7% vs. 30.9%; respectively). 

Statistically significant associations were also seen in the rate of Gd-enhancing lesions and new T2 lesions shown by MRI: 9.3% and 10.6% for the natalizumab group vs. 29.8% and 29.6% in the fingolimod group, respectively. At 2 years these figures were 9.1% and 16.9% for natalizumab vs. 22.1% and 34.1% for fingolimod.

The authors of the study stressed that the ultimate choice between natalizumab or fingolimod as a treatment rests on a number of different variables. The findings provide Class IV evidence for the superiority of natalizumab over fingolimod in preventing relapses for RRMS patients at 1 year.

For more information visit Neurology.