Fingolimod is better than the CRAB drugs

Braune S, Lang M, Bergmann A; NeuroTransData Study Group. Efficacy of fingolimod is superior to injectable disease modifying therapies in second-line therapy of relapsing remitting multiple sclerosis. J Neurol. 2015. [Epub ahead of print]

Although fingolimod is registered in Europe for treatment of relapsing-remitting multiple sclerosis (RRMS) if earlier disease modifying therapy (DMT) has failed, no data regarding its efficacy in this patient group are available. This observational cohort study of the NeuroTransData network includes German RRMS outpatients with failure of earlier therapy with injectable DMT (iDMT), therefore switching to either another iDMT (n = 133) or to fingolimod (n = 300). Statistical comparison of clinical baseline characteristics showed more severely affected patients in the fingolimod group. A propensity-score matched group comparison was performed (n = 99 in each group) covering more than 2-year observation time. Fingolimod showed statistically significant superior efficacy in comparison to iDMT regarding annualized relapse rate (0.21 versus 0.33 per year), time-to-relapse and likelihood of relapse (iDMT hazard ratio 1.7), proportion and likelihood of patients with EDSS progression (15.10 versus 31.00 %; iDMT hazard ratio 1.7), persistence on medication and likelihood of discontinuation (iDMT hazard ratio 3.0). Significantly more patients were free of relapse and EDSS progression with fingolimod than with their second iDMT (64.4 versus 46.5 %, p < 0.03). This real-life evidence in German RRMS outpatients support data from controlled clinical studies and can quantitatively support clinical decision finding processes if iDMT therapy fails in RRMS.

                                          CRAB Drugs:-)
This study looks at the response rate to inject CRAB (copaxone, rebif, avonex betaseron) and concluded that fingolimod was better at inhibiting relapses. So hot news? This is what should be expected

Maybe it is time that UK moved fingolimod as a first line treatment option rather than as a second line.  Its second line because of side effects you may say although in NICE’s eyes I bet it is because of drug-costs. The side efects are probably less than encountered with alemtuzumab which is first line in UK, third in USA.

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  • What is surprising is that any of the CRAB drugs are offered as a first line if the goal is to slow down or halt disease progression. If the goal in a RRMS patient is NEDA, Copaxone, Rebif, Avenox and Betaseron should only be offered if all the newer generation MS drugs are not tolerated, which would be highly improbable. Why are ridiculously expensive CRAB drugs even prescribed at all if they have zero effect of disease progression?

    • iI believe in new zealand it is either Fingolimod or Natalizumab as first line and the CRAB are not on the agenda

  • I'm so glad to have moved from Copaxone to Gilenya. It works FAR better, and even old chronic symptoms have improved on it. I've always felt that MS is a constant, on-going process and that "flareups" happen on top of that constant process going on under the radar. It's only the flareups that make the disease process recognizable on a grossly observable level, and so that's what we mainly associate with progression and damage. I'll bet that in the end we'll find that MS damage occurs all the time, and we were just missing it all along due to lack of technology, and I'd also argue a hefty dose of gender bias in the medical world.

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