Observational studyNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2023
The comparative effectiveness of fingolimod, natalizumab, and ocrelizumab in relapsing-remitting multiple sclerosis.
Observational study in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Comparative efficacy and safety of ocrelizumab in relapsing-remitting and primary progressive multiple sclerosis: A systematic review and meta-analysis.BMC neurology · 2025Pooled it
- Exit strategy patterns in second-line therapies for relapsing forms of multiple sclerosis.Acta neurologica Belgica · 2026Article
- Managing reactivation of multiple sclerosis during treatment with natalizumab.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- Comparative effectiveness, safety and persistence of ocrelizumab versus natalizumab in multiple sclerosis: A real-world, multi-center, propensity score-matched study.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Article
- Progression independent of relapsing biology in multiple sclerosis: a real-word study.Frontiers in neurology · 2025Article
- CONFIDENCE treatment success: long-term real-world effectiveness and safety of ocrelizumab in Germany.Frontiers in neurology · 2025Article
- Successful switch to ofatumumab after liver injury associated with ocrelizumab treatment in multiple sclerosis: a case report.Frontiers in neurology · 2024Article
- Comparative efficacy of ofatumumabTherapeutic advances in neurological disorders · 2024Article
Corrections and comments
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Authors and funding
20 authors at 16 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFingolimod, natalizumab, and ocrelizumab are commonly used in the second-line treatment of relapsing-remitting multiple sclerosis (RRMS). However, these have only been compared in observational studies, not in controlled trials, with limited and inconclusive results being reported. A comparison of their effect on relapse and disability in a real-world setting is therefore needed.
objectivesThe objective of this study was to compare the efficacy of fingolimod, natalizumab, and ocrelizumab in reducing disease activity in RRMS.
methodsThis multicenter, retrospective observational study was carried out with prospectively collected data from 16 centers. All consecutive RRMS patients treated with fingolimod, natalizumab, and ocrelizumab were included. Data for relapses, Expanded Disability Status Scale (EDSS) scores, and brain magnetic resonance imaging (MRI) scans were collected. Patients were matched using propensity scores. Annualized relapse rates (ARR), time to first relapse, and disability accumulation were compared.
resultsPropensity score matching retained 736 patients in the fingolimod versus 370 in the natalizumab groups, 762 in the fingolimod versus 434 in the ocrelizumab groups, and 310 in the natalizumab versus 310 in the ocrelizumab groups for final analyses. Mean ARR decreased markedly from baseline after treatment in all three treatment groups. Mean on-treatment ARR was lower in natalizumab-treated patients (0.09, 95% confidence interval (CI), 0.07-0.12) than in those treated with fingolimod (0.17, 0.15-0.19, p<0.001), ocrelizumab (0.08, 0.06-0.11), and fingolimod (0.14, 0.12-0.16, p=0.001). No significant difference was observed in mean on-treatment ARR between patients treated with natalizumab (0.08, 0.06-0.11) and ocrelizumab (0.09, 0.07-0.12, p=0.54). Compared to fingolimod, the natalizumab and ocrelizumab groups exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients at year 1. No significance differences in disability accumulation were determined between the therapies.
conclusionNatalizumab and ocrelizumab exhibited similar effects on relapse control, and both were associated with better relapse control than fingolimod. The effects of the three therapies on disability outcomes were similar.
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