MS treatments in real life.

Kalincik T, Jokubaitis V, Spelman T, Horakova D, Havrdova E, Trojano M, Lechner-Scott J, Lugaresi A, Prat A, Girard M, Duquette P, Grammond P, Solaro C, Grand'Maison F, Hupperts R, Prevost J, Sola P, Ferraro D, Terzi M, Butler E, Slee M, Kermode A, Fabis-Pedrini M, McCombe P, Barnett M, Shaw C, Hodgkinson S, Butzkueven H; MSBase Study Group. Cladribine versus fingolimod, natalizumab and interferon β for multiple sclerosis. Mult Scler. 2017: 1352458517728812. doi: 10.1177/1352458517728812. [Epub ahead of print]

OBJECTIVE:This propensity score-matched analysis from MSBase compared the effectiveness of cladribine with interferon β, fingolimod or natalizumab.
METHODS:We identified all patients with relapse-onset multiple sclerosis, exposure to the study therapies and ⩾1-year on-treatment follow-up from MSBase. Three pairwise propensity score-matched analyses compared treatment outcomes over 1 year. The outcomes were hazards of first relapse, disability accumulation and disability improvement events. Sensitivity analyses were completed.
RESULTS:The cohorts consisted of 37 (cladribine), 1940 (interferon), 1892 (fingolimod) and 1410 patients (natalizumab). The probability of experiencing a relapse on cladribine was lower than on interferon ( p = 0.05), similar to fingolimod ( p = 0.31) and higher than on natalizumab ( p = 0.042). The probability of disability accumulation on cladribine was similar to interferon ( p = 0.37) and fingolimod ( p = 0.089) but greater than natalizumab ( p = 0.021). The probability of disability improvement was higher on cladribine than interferon ( p = 0.00017), fingolimod ( p = 0.0025) or natalizumab ( p = 0.00099). Sensitivity analyses largely confirmed the above results.
CONCLUSION:Cladribine is an effective therapy for relapse-onset multiple sclerosis. Its effect on relapses is comparable to fingolimod and its effect on disability accrual is comparable to interferon β and fingolimod. Cladribine may potentially associate with superior recovery from disability relative to interferon, fingolimod and natalizumab 

The Guys from MSBase in Australia have gone through their registry to compare the effects of  a few drugs in real life, notably the big C, however in terms of the relapse rate it fell behind natalizumab in terms of halting relapses, but seemed to have some advantage when compared to the others in disability progression.

However we are comparing about forty people in the cladribine group against over a thousand in the other groups, and represents cladribine falling through the cracks, but what happened to extra 47-107 from ECTRIMS poster?

Guess the dose wasn't standard. However, we must await more data to surface, which will occur once cladribine comes back on the agenda in Australia, Europe and elsewhere.

COI: None real. 

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