Introduction
Patients and methods
Statistical analysis
Results
Data capture
Patient characteristics
Variable |
n = 1,364 |
---|---|
Sex | |
Female | 944 (69.3%) |
Male | 418 (30.7%) |
Mean ± SD age on diagnosis of MS, years | 29.6 ± 8.50 |
Mean ± SD time since diagnosis of MS, years | 9.62 ± 5.65 |
Mean ± SD age on starting natalizumab, years | 39.2 ± 8.95 |
Clinical form of MS prior to starting natalizumab | |
Relapsing–remitting | 1,173 (86.8%) |
Secondary progressive | 178 (13.2%) |
Prior MS treatments | |
No | 95 (7.0%) |
Yes | 1,268 (93%) |
One prior treatment | 603 (44.2%) |
Two prior treatments | 431 (31.6%) |
>2 prior treatments | 234 (17.1%) |
Interferon beta 1a SC | 655 (51.7%) |
Interferon beta 1b SC | 447 (35.3%) |
Interferon beta 1a IM | 364 (28.7%) |
Glatiramer acetate | 330 (26.0%) |
Immunosuppressants | 113 (8.9%) |
Mitoxantrone | 98 (7.7%) |
Methotrexate | 7 (0.6%) |
Cyclophosphamide | 9 (0.7%) |
Azathioprine | 4 (0.3%) |
Other treatments | 120 (9.5%) |
EDSS score in year prior to treatment | 3.0 (0.0–8.0) |
Annualized relapse rate in year prior to starting natalizumab | 2.0 (1–14) |
No. of T1 Gd-enhancing lesions prior to natalizumab | |
0 lesions | 530 (47.7%) |
1–5 lesions | 467 (42.0%) |
6–9 lesions | 49 (4.4%) |
>9 lesions | 66 (5.9%) |
Safety data: discontinuation of treatment
Safety data: hypersensitivity reactions, neutralizing antibodies, and concomitant infections
Efficacy outcomes
Outcome measure | Baseline | At 12 months/during 12-month treatment period | ||
---|---|---|---|---|
n
| Value |
n
| Value | |
Annualized relapse ratea
| 826 | Median 2.0 (0–14) | 825 | Median 0.0 (0–4)b
|
Mean 2.01 (1.92–2.11) | Mean 0.25 (0.21–0.29) | |||
Percentage of patients with at least one relapsea
| 826 | 733 (88.7%) | 825 | 168 (20.4%) |
Basal EDSS score | 839 | Median 3.50 (0–8.5) | 839 | 3.00 (0–7.5)c
|
Mean 3.71 (3.60–3.82) | Mean 3.37 (3.25–3.49) | |||
Patients with Gd-enhancing lesions at baseline | 563 | 289 (51.3%) | 563 | 33 (5.9%) |
Change in disease status | Time period relative to baseline | ||
---|---|---|---|
−12–0 months | 0–6 months | 6–12 months | |
Improvement | 3.55 | 17.52 | 23.77 |
Stability | 68.14 | 78.68 | 69.98 |
Worsening | 28.31 | 3.8 | 6.25 |
Discussion
Reference | Country/no. centers | No. patients | Duration of treatment | Mean ARR in year prior to treatment | Mean baseline EDSS |
---|---|---|---|---|---|
Putzki et al. [8] | Germany and Switzerland/5 | 97 (six previously untreated) | ≥12 months | 2.3 | 3.4 |
Oturia et al. [9] | Denmark/2 | 234 (175 after switching from DMT, 45 switching from mitoxantrone, 14 treatment naïve) | Median 11.3 months (range 3–21.5 months) | 2.53 | 4.0a
|
Sangalli et al. [10] | Italy/3 | 285 (233 after switching treatment, 52 treatment naïve) | Up to 2 years | 2.13 | Not reported |
Outteryck et al. [12] | France/not statedb
| 384 (5.6% treatment naïve; efficacy data for 127) | ≥12 months | 2.19 | 3.53 |
Prosperini et al. [11] | Italy/1 | 190 (efficacy data for 169) | Median 15 (range 1–29 months) | 2.0 | 3.4a
|
Mancardi et al. [15] | Italy/164 | 2,971 | – | – | – |
Putzki et al. [16] | Switzerland/3 | 85 (after failure of DMT) | Median 17.2 (range 12–31.4 months) | 2.0 | 3.1 |
Piehl et al. [17] | Sweden/36 | 1,115 | Mean 22 months | – | 3.86c
|
Fernández et al. [18] | Spain/1 | 77 | Mean 14.7 months | 0.96 | 3.18 |
Horga et al. [19] | Spain | 112 | Mean 15.8 months | 2.25 | 4.0 |
Fernández et al.d
| Spain/86 | 1,415 | Median 16 (range 1–50) | 2.23 | 3.23 |
AFFIRM/Polman et al. [4] | Multinational/99 | 627 (natalizumab) | 2 years | 1.53 (natalizumab) | 2.53 |
315 (placebo) | 1.50 (placebo) |
Reference | ARR at 1 year | Decrease in ARR at 1 year with respect to previous year (%)e
| Patients relapse free after 1 year (%) | Change in mean EDSS after 1 year | Patients with EDSS progression (≥1.p point increase) at 1 year (%) |
---|---|---|---|---|---|
Putzki et al. [8] | 0.2 | 91 | 80.4 | 0.4 | 10 |
Oturia et al. [9] | 0.68 | 73 | 63 | – | 9 |
Sangalli et al. [10] | 0.26 | 88 | 84 (78% at 2 years) | – | – |
Outteryck et al. [12] | 0.59 | 73 | 60 | 0.5 | – |
Prosperini et al. [11] | 0.22 | 90a
| 85a
| 0.2c
| – |
Putzki et al. [16] | 0.27 | 87 | 78b
| 0.2 | 7 |
Piehl et al. [17] | – | – | – | 0.48d
| – |
Fernández et al. [18] | 0.13 | 86 | – | 0.05 | – |
Horga et al. [19] | 0.24 | 89 | 80.3 | 0.2 | 9.2 |
Fernández et al.f
| 0.25 | 88 | 80 | 0.5e
| 6 |
AFFIRM/Polman et al. [4] | 0.26 (natalizumab) | 83 | 77 (natalizumab) | – | 13 (natalizumab) |
0.81 (placebo) | 54 | 56 (placebo) | 21 (placebo) |
Reference | Discontinuations | Hypersensitivity reactions | Neutralizing antibodies |
---|---|---|---|
Putzki et al. [8] | 8 (8.2%) | 2 (2.1%)a
| 4 (4.1%)b
|
Oturia et al. [9] | 27 (12%) | 9 (3.8%) | 7 (2.9%) |
Sangalli et al. [10] | 34 (12%) | 18 (6.3%) | 19 (6.6%) |
Outteryck et al. [12] | 35 (9.1%) | 15 (3.9%) | 5 (1.3%)b
|
Prosperini et al. [11] | 31 (16.3%) | 4 (2.1%)a
| 19 (10%)c
|
Putzki et al. [16] | 10 (12%) | 2 (2.4%)a
| 6 (7.1%)b
|
Piehl et al. [17] | 116 (10.4%) | – | 39 (3.9%) |
Fernández et al. [18] | 13 (16.8%) | 1 (1.3%) | 9 (11.7%) |
Horga et al. [19] | 16 (14.4%) | 5 (4.5%) | – |
Fernández et al.d
| 176 (14%) | 46 (3.6%) | 34 (3.1%)c
|
AFFIRM/Polman et al. [4] | 3.8% (natalizumab) | 9% (natalizumab) | 57 (9%) |
4.8% (placebo) | 4% (placebo) | – |