Fingol against Nataliziumab…and the Winner is….

BACKGROUND:Although Fingolimod (FGD) and Natalizumab (NTZ) appear to be effective in relapsing-remitting multiple sclerosis (RRMS), they have never been directly compared in a randomized clinical trial (RCT).
METHODS AND FINDINGS: We evaluated the comparative efficacy of FGD vs. NTZ using a meta-analytical approach. Data from placebo-controlled RCTs was used for indirect comparisons and observational data was utilized for head-to-head comparisons. We identified 3 RCTs (2498 patients) and 5 observational studies (2576 patients). NTZ was associated with a greater reduction in the 2-year annualized relapse rate (ARR; SMDindirect = -0.24;95% CI: from -0.44 to -0.04; p = 0.005) and with the probability of no disease activity at 2 years (ORindirect:1.82, 95% CI: from 1.05 to 3.15) compared to FGD, while no differences between the two therapies were found in the proportion of patients who remained relapse-free (ORindirect = 1.20;95% CI: from 0.84 to 1.71) and those with disability progression (ORindirect = 0.76;95% CI: from 0.48 to 1.21) at 2 years. In the analysis of observational data, we found no significant differences between NTZ and FGD in the 2-year ARR (SMD = -0.05; 95% CI: from -0.26 to 0.16), and 2-year disability progression (OR:1.08;95% CI: from 0.77 to 1.52). However, NTZ-treated patients were more likely to remain relapse-free at 2-years compared to FGD (OR: 2.19;95% CI: from 1.15 to 4.18; p = z0.020).
CONCLUSIONS: Indirect analyses of RCT data and head-to-head comparisons of observational findings indicate that NTZ may be more effective than FGD in terms of disease activity reduction in patients with RRMS. However, head-to-head RCTs are required to independently confirm this preliminary observation.




You have been asking for comparisons of different drugs, but it cant be horses for courses because it is clear that efficacy is not top of the list otherwise we would not be going to the CRAB drugs. However, it is a balancee between efficacy, conveninece, safety etc etc etc. In this study they try and compare fingolimod and come to the conclusion that natalizumab is abit more efficacious. This is not a head to head, and companies are never going to do this exept when it is a no-brainer e.g. they put a new drug against beta interferon, like alemtuzumab and oceliziumab and it is obvious that the latter two are better than the CRAB drugs. However it can backfire, look at laquinimod verses beta interferon…oooops. Academics want to do these studies, but they cost too much  to do. The funders say is this a good use of our limited resource and the answer is usually no. Maybe the regulators should insist that drugs are compared to current best practise, but then we may get no new drugs as to show your new drug is better than a good drug is going to mean the studies are very large…and costly.