Natalizumab and Fingolimod in real life studies


As you know I am not a neurologists and am not making any recommendations but this study looked at the real life effect of natalizumab and fingolimod as the two major migration inhibitors.

Andersen JB et al. The effectiveness of natalizumab vs fingolimod – a comparison of international registry studies. MSARDS 2021. DOI:

Background:Natalizumab and fingolimod were the first preparations recommended for disease breakthrough in priorly treated relapsing-remitting multiple sclerosis. Of three published head-to-head studies two showed that natalizumab is the more effective to prevent relapses and EDSS worsening.

Methods: By re-analyzing original published results from MSBase, France, and Denmark using uniform methodologies, we aimed at identifying the effects of differences in methodology, in the MS-populations, and at re-evaluating the differences in effectiveness between the two drugs.We gained access to copies of the individual amended databases and pooled all data. We used uniform inclusion/exclusion criteria and statistical methods with Inverse Probability Treatment Weighting.

Results: The pooled analyses comprised 968 natalizumab- and 1479 fingolimod treated patients. The on-treatment natalizumab/fingolimod relapse rate ratio was 0.77 (p=0.004). The hazard ratio (HR) for a first relapse was 0.82 (p=0.030), and the HR for sustained EDSS improvement was 1.4 (p=0.009). There were modest differences between each of the original published studies and the replication study, but the conclusions of the three original studies remained unchanged: in two of them natalizumab was more effective, but in the third there was no difference between natalizumab and fingolimod.

Conclusion: The results were largely invariant to the epidemiological and statistical methods but differed between the MS populations. Generally, the advantage of natalizumab was confirmed.

Disclaimer: Please note that the opinions expressed here are those of author and do not necessarily reflect the position of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust.

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1 comment

  • I am a 54 year old man. I have rrms, diagnosed in 1999. Moved from Avonex to Fingolimod by my Neuro. ten years ago…

    Are the benefits enough and is this evidence enough to ask to move from Fingolimod to natalizumab?

    Is this safe to do with the ms rebound risks of stopping Fingolimod?


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