Comparison of the effectiveness of ocrelizumab vs interferon b, fingolimod and natalizumab on relapses in relapsing-remitting multiple sclerosis.

Abstract

Objective To compare the effectiveness of ocrelizumab with interferon-b, fingolimod and natalizumab in relapsing-remitting multiple sclerosis (MS). Method Using the MSBase registry, we identified patients with relapsing-remitting MS treated for >=6 months with ocrelizumab, interferons (interferon beta-1a, interferon b-1b subcutaneous or interferon b-1b intramuscular), fingolimod or natalizumab. Patients were matched with propensity score on baseline age, sex, MS duration, EDSS, relapse rate, prior therapy, disease activity, MRI, reason for discontinuation of preceding therapy and country. Annualised relapse rates (ARR) and cumulative hazard of relapses were compared in pairwise-censored groups. Results 106 patients treated with ocrelizumab were matched with 209 patients on interferon therapies. Over a pairwisecensored mean follow-up of 1.3 years, ocrelizumab was associated with lower relapse rates (ARR 0.08 vs 0.27, p<0.001) and lower risk of relapse (HR 0.30, 95%CI 0.15-0.57) than interferon-b. 297 patients treated with ocrelizumab were matched with 811 fingolimod-treated patients. Over a pairwise- censored mean follow-up of 1.5 years, ocrelizumab was associated with lower relapse rates (ARR 0.03 vs 0.14, p<0.001) and lower risk of relapse than fingolimod (HR 0.21, 0.13-0.32). 262 ocrelizumab-treated patients were matched with 343 natalizumab treated. Over a pairwise-censored mean follow-up of 1.6 years, ocrelizumab and natalizumab were associated with similar relapse rates (ARR 0.06 vs 0.08, p=0.39) and risk of relapse (HR 0.77, 0.45-1.33). Conclusions Treatment with ocrelizumab provides superior control of relapses than interferon-b and fingolimod. The effects of ocrelizumab and natalizumab on relapse activity are similar. Further evaluation of the comparative effectiveness of ocrelizumab on disability accumulation is warranted.