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Rituximab versus Fi...
Rituximab versus Fingolimod after Natalizumab in Multiple Sclerosis Patients
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- Alping, P. (author)
- Karolinska Institutet
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- Frisell, T. (author)
- Karolinska Institutet
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- Novakova, Lenka, 1984 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
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- Islam-Jakobsson, P. (author)
- Umeå universitet,Klinisk neurovetenskap
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- Salzer, Jonatan (author)
- Umeå universitet,Klinisk neurovetenskap
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Bjorck, A. (author)
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- Axelsson, Markus, 1975 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
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- Malmeström, Clas, 1965 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
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- Fink, K. (author)
- Karolinska Institutet
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- Lycke, Jan, 1956 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
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- Svenningsson, Anders (author)
- Karolinska Institutet,Umeå universitet,Klinisk neurovetenskap,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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- Piehl, F. (author)
- Karolinska Institutet
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(creator_code:org_t)
- 2016-04-20
- 2016
- English.
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In: Annals of Neurology. - : Wiley. - 0364-5134 .- 1531-8249. ; 79:6, s. 950-958
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Abstract
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- Objective: Many JC virus antibody-positive relapsing-remitting multiple sclerosis (RRMS) patients who are stable on natalizumab switch to other therapies to avoid progressive multifocal leukoencephalopathy. Methods: We compared outcomes for all RRMS patients switching from natalizumab due to JC virus antibody positivity at 3 Swedish multiple sclerosis centers with different preferential use of rituximab and fingolimod (Stockholm, n = 156, fingolimod 51%; Gothenburg, n = 64, fingolimod 88%; Umea, n = 36, fingolimod 19%), yielding a total cohort of N = 256 (fingolimod 55%). Results: Within 1.5 years of cessation of natalizumab, 1.8% (rituximab) and 17.6% (fingolimod) of patients experienced a clinical relapse (hazard ratio for rituximab = 0.10, 95% confidence interval [CI] = 0.02-0.43). The hazard ratio (favoring rituximab) for adverse events (5.3% vs 21.1%) and treatment discontinuation (1.8% vs 28.2%) were 0.25 (95% CI = 0.10-0.59) and 0.07 (95% CI = 0.02-0.30), respectively. Furthermore, contrast-enhancing lesions were found in 1.4% (rituximab) versus 24.2% (fingolimod) of magnetic resonance imaging examinations (odds ratio = 0.05, 95% CI = 0.00-0.22). Differences remained when adjusting for possible confounders (age, sex, disability status, time on natalizumab, washout time, follow-up time, and study center). Interpretation: Our findings suggest an improved effectiveness and tolerability of rituximab compared with fingolimod in stable RRMS patients who switch from natalizumab due to JC virus antibody positivity. Although residual confounding factors cannot be ruled out, the shared reason for switching from natalizumab and the preferential use of either rituximab or fingolimod in 2 of the centers mitigates these concerns.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Neurovetenskaper (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Neurosciences (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Keyword
- PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY
- RISK STRATIFICATION
- ORAL
- FINGOLIMOD
- DOUBLE-BLIND
- TRIAL
- THERAPY
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Alping, P.
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Frisell, T.
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Novakova, Lenka, ...
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Islam-Jakobsson, ...
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Salzer, Jonatan
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Bjorck, A.
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show more...
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Axelsson, Markus ...
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Malmeström, Clas ...
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Fink, K.
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Lycke, Jan, 1956
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Svenningsson, An ...
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Piehl, F.
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Basic Medicine
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and Neurosciences
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Neurology
- Articles in the publication
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Annals of Neurol ...
- By the university
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University of Gothenburg
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Umeå University
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Karolinska Institutet