Ocrelizumab versus fingolimod after natalizumab cessation in multiple sclerosis: an observational study

Background Exit strategy after natalizumab cessation in multiple sclerosis (MS) is a crucial point because the risk of disease reactivation is high during this period. The objective of this observational study was to compare ocrelizumab to fingolimod after natalizumab cessation in patients with relapsing-remitting multiple sclerosis (RRMS). Methods All RRMS patients starting fingolimod or ocrelizumab within 6 weeks after natalizumab cessation were included. The primary endpoint was the annualized relapse rate (ARR) at 1 year. Results We included 54 patients receiving fingolimod and 48 patients receiving ocrelizumab after natalizumab cessation. In multivariate analysis, ARR at 1 year was significantly lower in the ocrelizumab group than in the fingolimod group (0.12 +/- 0.39 versus 0.41 +/- 0.71, p = 0.026), i.e. a 70.7% lower relapse rate. The cumulative probability of relapses at 1 year was 31.5% (17/54 patients) with fingolimod and 10.4% (5/48 patients) with ocrelizumab, corresponding to a hazard ratio of 3.4 (95% confidence interval: 1.1-11, p = 0.04). Conclusions Our results suggest ocrelizumab is potentially a better exit strategy than fingolimod after natalizumab cessation.

Automated summary

This study compared the effectiveness of ocrelizumab and fingolimod after natalizumab cessation. The results showed that ocrelizumab had a significantly lower relapse rate at 1 year compared to fingolimod.