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Thread: Pts did better on Rituximab than Fingolimod after JC+ switch from Tysabri

  1. #1
    Distinguished Community Member SuzE-Q's Avatar
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    Default Pts did better on Rituximab than Fingolimod after JC+ switch from Tysabri

    Thought this was interesting:

    http://www.ncbi.nlm.nih.gov/pubmed/27038238

    Ann Neurol. 2016 Mar 31. doi: 10.1002/ana.24651. [Epub ahead of print]

    Rituximab versus fingolimod after natalizumab in multiple sclerosis patients.

    Alping P1, Frisell T2, Novakova L3, Islam-Jakobsson P4, Salzer J4, Björck A1, Axelsson M3, Malmeström C3, Fink K1, Lycke J3, Svenningsson A4, Piehl F1.

    Abstract
    OBJECTIVE:
    Many JC-virus antibody positive relapsing-remitting multiple sclerosis (RRMS) patients 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 three Swedish MS centres with different preferential use of rituximab and fingolimod, respectively; Stockholm n=156 (fingolimod 51%); Gothenburg n=64 (fingolimod 88%); Umeå 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% CI: 0.02-0.43)). The hazard ratio (favouring 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) vs 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 centre).

    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 two of the centres mitigates these concerns.

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    Distinguished Community Member Cherie's Avatar
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    Rituxan is an easy drug to tolerate in my opinion. I've had 4 doses in the past two years but continue to feel like I am slipping. Will do blood work later this week to see if B-Cells have repopulated so I can start on Lemtrada.

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  5. #3
    Distinguished Community Member SuzE-Q's Avatar
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    Quote Originally Posted by Cherie View Post
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    Rituxan is an easy drug to tolerate in my opinion. I've had 4 doses in the past two years but continue to feel like I am slipping. Will do blood work later this week to see if B-Cells have repopulated so I can start on Lemtrada.
    Are you JC+, Cherie?

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    Distinguished Community Member Cherie's Avatar
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    Yes. I converted 6 years ago.

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    Distinguished Community Member Lazarus's Avatar
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    Thanks for posting the study.

    I am JC+ and have been taking rituximab for the last 5 or 6 years...I actually forget how many!

    the protocol is to do it every 6 months. Rituximab works so well for me that we have been stretching the time between infusions to eight months. Just this month I am on a 6 month schedule. So, I guess we are playing it by ear depending ....
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"

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