Comparison of switch to fingolimod or interferon beta/ XXXX in active @entity15 .

@entity1 @entity717 @entity15 @entity1638
IMPORTANCE: After @entity15 ( @entity15 ) relapse while a @entity1 is receiving an injectable disease-modifying drug, many physicians advocate therapy switch, but the relative effectiveness of different switch decisions is often uncertain. OBJECTIVE: To compare the effect of the oral immunomodulator fingolimod with that of all injectable immunomodulators (interferons or @entity1638 ) on relapse rate, disability, and treatment persistence in @entity1 with active @entity15 . DESIGN, SETTING, AND @entity1 : Matched retrospective analysis of data collected prospectively from MSBase, an international, observational cohort study. The MSBase cohort represents a population of @entity1 with @entity15 monitored at large @entity15 centers. The analyzed data were collected between July 1996 and April 2014. @entity1 included @entity1 with relapsing-remitting @entity15 who were switching therapy to fingolimod or injectable immunomodulators up to 12 months after on-treatment clinical disease activity (relapse or @entity717 ), matched on demographic and clinical variables. Median follow-up duration was 13.1 months (range, 3-80). Indication and attrition bias were controlled with propensity score matching and pairwise censoring, respectively. Head-to-head analyses of relapse and disability outcomes used paired, weighted, negative binomial models or frailty proportional hazards models adjusted for magnetic resonance imaging variables. Sensitivity analyses were conducted. EXPOSURES: @entity1 had received fingolimod, interferon beta, or @entity1638 for a minimum of 3 months following a switch of immunomodulatory therapy. MAIN OUTCOMES AND MEASURES: Annualized relapse rate and proportion of relapse-free @entity1 , as well as the proportion of @entity1 without sustained disability progression. RESULTS: Overall, 379 @entity1 in the injectable group were matched to 148 @entity1 in the fingolimod group. The fingolimod group had a lower mean annualized relapse rate (0.31 vs 0.42; 95% CI, 0.02-0.19; P=.009), lower hazard of first on-treatment relapse (hazard ratio [HR], 0.74; 95% CI, 0.56-0.98; P=.04), lower hazard of disability progression (HR, 0.53; 95% CI, 0.31-0.91; P=.02), higher rate of disability regression (HR, 2.0; 95% CI, 1.2-3.3; P=.005), and lower hazard of treatment discontinuation (HR, 0.55; P=.04) compared with the injectable group. CONCLUSIONS AND RELEVANCE: Switching from injectable immunomodulators to fingolimod is associated with fewer relapses, more favorable disability outcomes, and greater treatment persistence compared with switching to another injectable preparation following on-treatment activity of @entity15 .
