Scientists have conducted a study that looks at how traditional initial disease modifying treatment (DMT) choices, including dimethyl fumarate, fingolimod, or natalizumab compare with rituximab in relapsing remitting multiple sclerosis (RRMS) in terms of drug discontinuation and clinical efficacy.
The cohort population-based study consisted of 494 patients from two Swedish counties (Västerbotten and Stockholm) of which 99 patients did not fulfil the inclusion criteria. It was published in JAMA Journal.
Patients who started by taking rituximab stopped taking the drug at a rate of 0.03 per year. When compared to those taking first-generation therapies including the interferon-betas (Biogen’s Avonex and EMD Serono’s Rebif) and glatiramer acetate (Teva’s Copaxone) stopped at a rate of 0.53 per year. Dimethyl fumarate (Biogen’s Tecfidera) saw a stop rate of 0.32 per year, fingolimod (Novartis’ Gilenya) 0.38 per year, and natalizumab (Biogen’s Tysabri) 0.29 per year.
In addition, patients taking rituximab experienced fewer relapses and new brain lesions seen on MRI. However, the difference was not statistically significant enough for fingolimod and natalizumab.
Continued disease activity was the main reason for discontinuation of injectable DMTs, dimethyl fumarate and fingolimod. Positive John Cunningham virus serology results were the main reason for discontinuation of natalizumab.
The rate of clinical relapses and/or neuroradiologic disease activity were significantly lower for rituximab compared with injectable DMTs and dimethyl fumarate, with a tendency for lower relapse rates also compared with natalizumab and fingolimod. The annual discontinuation rate of initial treatment choice was significantly lower in Västerbotten compared with Stockholm (0.09 and 0.37, respectively).
Researchers concluded that rituximab was superior to all other DMT in terms of drug discontinuation and displayed better clinical efficacy compared with injectable DMTs and dimethyl fumarate with borderline significance compared with natalizumab and fingolimod. The county where rituximab constituted the main initial treatment choice displayed better outcomes in most measured variables. Collectively, our findings suggest that rituximab performs better than other commonly used DMTs in patients with newly diagnosed RRMS.
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