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Switching from natalizumab to moderate- versus high-efficacy DMT

Multiple sclerosis (MS) patients switching from natalizumab to another high-efficacy therapy had more favourable inflammatory and disability outcomes after 24 months than patients who deescalated to a moderate-efficacy disease-modifying therapy (DMT), which yielded greater disability progression [1].

The effect of such a treatment change was assessed after 24 months of follow-up. The 556 participants discontinued natalizumab treatment between 2005 and 2018 for various reasons, including progressive multifocal leukoencephalopathy risk (54.9%), breakthrough disease (15.3%), and adverse effects (17.3%). Of those participants, 270 (48.6%) switched to moderate-efficacy DMT (dimethyl fumarate, n=130; fingolimod, n=140), while 130 (23.4%) switched to high-efficacy therapy (ocrelizumab, n=106; rituximab, n=17; alemtuzumab, n=7).

At 24 months, there were no differences in annualised relapse rate (OR 1.44; 95% CI 0.69-1.59; P=0.334). However, a significantly ...

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