Clinical Characteristics and Treatment Outcomes in Anti-CD20-treated Multiple Sclerosis Patients Who Switch to Natalizumab: A Komodo Health Sentinel Database Study
Jonathan Calkwood1, Jeffrey English2, Harry Lay3, Daniel Long4, Yang Mao-Draayer5, Claire Riley6, Thomas Shoemaker7, Lana Zhovtis Ryerson8, Nicholas Belviso9, Sarah England9, Danette Rutledge9
1Minnesota Center for Multiple Sclerosis, 2Atlanta Neuroscience Institute, 3Raleigh Neurology Associates, 4Neuroscience Group, 5Oklahoma Medical Research Foundation, 6Columbia University Medical Center, 7Rush University Medical Center, 8Jersey Shore University Medical Center, 9Biogen
Objective:
To determine the clinical characteristics of patients with multiple sclerosis (MS) who switch from B-cell depleting therapies (anti-CD20s) to natalizumab (NTZ; TYSABRI®); to estimate the annualized relapse rate (ARR), time to first relapse, and MS healthcare resource utilization (HRU) and healthcare costs (HCC).
Background:
NTZ and anti-CD20s are high-efficacy disease-modifying therapies (DMTs) approved to treat relapsing forms of MS. There is a paucity of published data on patients switching from anti-CD20s to NTZ.
Design/Methods:
Retrospective US claims data from 01Jan2016-15Apr2023 were used; index date was defined as the earliest date of the first NTZ claim following switch from anti-CD20. This analysis included adult patients with a diagnosis of MS (ICD-10-G35) who switched from any anti-CD20 to NTZ during the study period, with 12 months pre-index medical/pharmacy continuous enrolment.
Results:
Overall, 188 MS patients treated with anti-CD20 therapy (ocrelizumab, n=170; rituximab, n=18) met eligibility criteria; mean age: 43.5 years; 77% were female. The mean (SD) days on anti-CD20 was 489.6 (325.1). Most (120/188 [64%]) were treated with anti-CD20 for >360 days. Of the remaining 68 patients treated with anti-CD20 for <360, 19 received NTZ directly preceding anti-CD20. The mean (SD) duration (washout) from the last dose of anti-CD20 to NTZ initiation was 158.1 (68.7) days; duration of NTZ exposure was 440 (380) days. Overall, ARR (95% CI) was 0.21 (0.14, 0.32) while treated with anti-CD20, and 0.17 (0.11, 0.26) after switching to NTZ (rate ratio [95% CI]: 0.81 [0.48, 1.36]; p=0.42). The Kaplan Meier-estimated proportion of relapse-free patients at 12-months after switching from anti-CD20 to NTZ was 85.2% (79.4, 91.4). HRU and HCC were not statistically significant between the groups.
Conclusions:
Patients with MS who switched from anti-CD20 to NTZ in this claims database maintained similar ARR, percent of patients relapse-free, HCC, and HCRU. The long-term safety of this sequencing approach requires further research.
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