Skip to main content
Top
Published in: Neurological Sciences 10/2020

Open Access 01-10-2020 | Multiple Sclerosis | Original Article

Effectiveness of fingolimod in real-world relapsing-remitting multiple sclerosis Italian patients: the GENIUS study

Authors: Giancarlo Comi, Carlo Pozzilli, Vincenzo Brescia Morra, Antonio Bertolotto, Francesca Sangalli, Luca Prosperini, Antonio Carotenuto, Pietro Iaffaldano, Marco Capobianco, Delia Colombo, Mihaela Nica, Sara Rizzoli, Maria Trojano

Published in: Neurological Sciences | Issue 10/2020

Login to get access

Abstract

Background

Fingolimod is the first oral agent approved for treatment of relapsing-remitting multiple sclerosis (RRMS). We aimed to evaluate fingolimod effectiveness in a real-world sample of RRMS patients.

Methods

A retrospective, multicentre study in patients treated with fingolimod, whom clinical and radiological data were collected in the 2 years preceding and following the initiation of fingolimod.

Results

Out of 414 patients, 56.8% received prior first-line injectable disease-modifying therapies, 25.4% were previously treated with natalizumab, 1.2% with immunosuppressant agents, and 16.7% were treatment naive. The annualized relapse rate decreased by 65% in the first year and by 70% after two years of treatment. Age ≤ 40 years, ≥ 1 relapse in the 24 months before fingolimod initiation and previous treatment with natalizumab were risk factors for relapses. Overall, 67.9% patients had no evidence of disease activity (NEDA-3) after 1 year and 54.6% after 2 years of treatment. A higher proportion of naïve (81.2% in 1 year and 66.7% after 2 years) or first-line injected patients (70.2% and 56.6%) achieved NEDA-3 than those previously treated with natalizumab (54.3% and 42.9%).

Conclusions

Fingolimod appeared to be effective in naive patients and after first-line treatment failure in reducing risk of relapse and disease activity throughout the 2-year follow-up.
Appendix
Available only for authorised users
Literature
1.
go back to reference Calabresi PA, Radue EW, Goodin D et al (2014) Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol 13(6):545–556CrossRef Calabresi PA, Radue EW, Goodin D et al (2014) Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol 13(6):545–556CrossRef
2.
go back to reference Kappos L, Radue EW, O'Connor P et al (2010) A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med 362(5):387–401CrossRef Kappos L, Radue EW, O'Connor P et al (2010) A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med 362(5):387–401CrossRef
3.
go back to reference Cohen JA, Barkhof F, Comi G et al (2010) Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med 362(5):402–415CrossRef Cohen JA, Barkhof F, Comi G et al (2010) Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med 362(5):402–415CrossRef
4.
go back to reference Kappos L, O'Connor P, Radue EW et al (2015) Long-term effects of fingolimod in multiple sclerosis: the randomized FREEDOMS extension trial. Neurology 84(15):1582–1591CrossRef Kappos L, O'Connor P, Radue EW et al (2015) Long-term effects of fingolimod in multiple sclerosis: the randomized FREEDOMS extension trial. Neurology 84(15):1582–1591CrossRef
5.
go back to reference Cohen JA, Khatri B, Barkhof F et al (2016) Long-term (up to 4.5 years) treatment with fingolimod in multiple sclerosis: results from the extension of the randomised TRANSFORMS study. J Neurol Neurosurg Psychiatry 87(5):468–475CrossRef Cohen JA, Khatri B, Barkhof F et al (2016) Long-term (up to 4.5 years) treatment with fingolimod in multiple sclerosis: results from the extension of the randomised TRANSFORMS study. J Neurol Neurosurg Psychiatry 87(5):468–475CrossRef
8.
go back to reference Esposito F, Ferrè L, Clarelli F et al (2018) Effectiveness and baseline factors associated to fingolimod response in a real-world study on multiple sclerosis patients. J Neurol 265(4):896–905CrossRef Esposito F, Ferrè L, Clarelli F et al (2018) Effectiveness and baseline factors associated to fingolimod response in a real-world study on multiple sclerosis patients. J Neurol 265(4):896–905CrossRef
9.
go back to reference Zivadinov R, Khan N, Korn JR et al (2018) No evidence of disease activity in patients receiving fingolimod at private or academic centers in clinical practice: a retrospective analysis of the multiple sclerosis, clinical, and magnetic resonance imaging outcomes in the USA (MS-MRIUS) study. Curr Med Res Opin 34(8):1431–1440CrossRef Zivadinov R, Khan N, Korn JR et al (2018) No evidence of disease activity in patients receiving fingolimod at private or academic centers in clinical practice: a retrospective analysis of the multiple sclerosis, clinical, and magnetic resonance imaging outcomes in the USA (MS-MRIUS) study. Curr Med Res Opin 34(8):1431–1440CrossRef
10.
go back to reference Prosperini L, Saccà F, Cordioli C et al (2017) Real-world effectiveness of natalizumab and fingolimod compared with self-injectable drugs in non-responders and in treatment-naïve patients with multiple sclerosis. J Neurol 264(2):284–294CrossRef Prosperini L, Saccà F, Cordioli C et al (2017) Real-world effectiveness of natalizumab and fingolimod compared with self-injectable drugs in non-responders and in treatment-naïve patients with multiple sclerosis. J Neurol 264(2):284–294CrossRef
11.
go back to reference Al-Hashel J, Ahmed SF, Behbehani R et al (2014) Real-world use of fingolimod in patients with relapsing remitting multiple sclerosis: a retrospective study using the national multiple sclerosis registry in Kuwait. CNS Drugs 28(9):817–824CrossRef Al-Hashel J, Ahmed SF, Behbehani R et al (2014) Real-world use of fingolimod in patients with relapsing remitting multiple sclerosis: a retrospective study using the national multiple sclerosis registry in Kuwait. CNS Drugs 28(9):817–824CrossRef
12.
go back to reference Zecca C, Roth S, Findling O et al (2018) Real-life long-term effectiveness of fingolimod in Swiss patients with relapsing-remitting multiple sclerosis. Eur J Neurol 25(5):762–767CrossRef Zecca C, Roth S, Findling O et al (2018) Real-life long-term effectiveness of fingolimod in Swiss patients with relapsing-remitting multiple sclerosis. Eur J Neurol 25(5):762–767CrossRef
13.
go back to reference Bianco A, Patanella AK, Nociti V, Marti A, Frisullo G, Plantone D, de Fino C, Fetta A, Batocchi AP, Rossini PM, Mirabella M (2015) Second-line therapy with fingolimod for relapsing-remitting multiple sclerosis in clinical practice: the effect of previous exposure to natalizumab. Eur Neurol 73(1–2):57–65CrossRef Bianco A, Patanella AK, Nociti V, Marti A, Frisullo G, Plantone D, de Fino C, Fetta A, Batocchi AP, Rossini PM, Mirabella M (2015) Second-line therapy with fingolimod for relapsing-remitting multiple sclerosis in clinical practice: the effect of previous exposure to natalizumab. Eur Neurol 73(1–2):57–65CrossRef
15.
go back to reference Hohlfeld R, Kappos L, Tomic D et al (2017) Early fingolimod treatment improves disease outcomes at 2 and 4 years in patients with relapsing-remitting multiple sclerosis. Neurology 88(16 Suppl):6, 332 Hohlfeld R, Kappos L, Tomic D et al (2017) Early fingolimod treatment improves disease outcomes at 2 and 4 years in patients with relapsing-remitting multiple sclerosis. Neurology 88(16 Suppl):6, 332
17.
go back to reference Kalincik T, Horakova D, Spelman T et al (2015) Switch to natalizumab versus fingolimod in active relapsing-remitting multiple sclerosis. Ann Neurol 77(3):425–435CrossRef Kalincik T, Horakova D, Spelman T et al (2015) Switch to natalizumab versus fingolimod in active relapsing-remitting multiple sclerosis. Ann Neurol 77(3):425–435CrossRef
18.
go back to reference Lanzillo R, Carotenuto A, Moccia M et al (2017) A longitudinal real-life comparison study of natalizumab and fingolimod. Acta Neurol Scand 136(3):217–222CrossRef Lanzillo R, Carotenuto A, Moccia M et al (2017) A longitudinal real-life comparison study of natalizumab and fingolimod. Acta Neurol Scand 136(3):217–222CrossRef
19.
go back to reference Havrdova E, Galetta S, Stefoski D et al (2010) Freedom from disease activity in multiple sclerosis. Neurology 74(Suppl 3):S3–S7CrossRef Havrdova E, Galetta S, Stefoski D et al (2010) Freedom from disease activity in multiple sclerosis. Neurology 74(Suppl 3):S3–S7CrossRef
20.
go back to reference Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302CrossRef Polman CH, Reingold SC, Banwell B et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302CrossRef
21.
go back to reference Thompson AJ, Banwell BL, Barkhof F et al (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17(2):162–173CrossRef Thompson AJ, Banwell BL, Barkhof F et al (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17(2):162–173CrossRef
24.
go back to reference González-Suarez I, Rodríguez de Antonio L, Orviz A, et al. (2017) Catastrophic outcome of patients with a rebound after natalizumab treatment discontinuation. Brain Behav. 7(4): e00671. doi: https://doi.org/10.1002/brb3.671. eCollection 2017 Apr. González-Suarez I, Rodríguez de Antonio L, Orviz A, et al. (2017) Catastrophic outcome of patients with a rebound after natalizumab treatment discontinuation. Brain Behav. 7(4): e00671. doi: https://​doi.​org/​10.​1002/​brb3.​671. eCollection 2017 Apr.
25.
go back to reference Rinaldi F, Seppi D, Calabrese M et al (2012) Switching therapy from natalizumab to fingolimod in relapsing-remitting multiple sclerosis: clinical and magnetic resonance imaging findings. Mult Scler 18(11):1640–1643CrossRef Rinaldi F, Seppi D, Calabrese M et al (2012) Switching therapy from natalizumab to fingolimod in relapsing-remitting multiple sclerosis: clinical and magnetic resonance imaging findings. Mult Scler 18(11):1640–1643CrossRef
27.
go back to reference Kappos L, Radue EW, Comi G et al (2015) Switching from natalizumab to fingolimod: a randomized, placebo-controlled study in RRMS. Neurology 85(1):29–39CrossRef Kappos L, Radue EW, Comi G et al (2015) Switching from natalizumab to fingolimod: a randomized, placebo-controlled study in RRMS. Neurology 85(1):29–39CrossRef
28.
go back to reference Comi G, Gold R, Dahlke F, Sinha A, von Rosenstiel P, Tomic D, Kappos L (2015) Relapses in patients treated with fingolimod after previous exposure to natalizumab. Mult Scler 21:786–790CrossRef Comi G, Gold R, Dahlke F, Sinha A, von Rosenstiel P, Tomic D, Kappos L (2015) Relapses in patients treated with fingolimod after previous exposure to natalizumab. Mult Scler 21:786–790CrossRef
29.
go back to reference Martínez-Yélamos S, Martínez-Yélamos A, Martín Ozaeta G et al (2006) Regression to the mean in multiple sclerosis. Mult Scler 12(6):826–829CrossRef Martínez-Yélamos S, Martínez-Yélamos A, Martín Ozaeta G et al (2006) Regression to the mean in multiple sclerosis. Mult Scler 12(6):826–829CrossRef
Metadata
Title
Effectiveness of fingolimod in real-world relapsing-remitting multiple sclerosis Italian patients: the GENIUS study
Authors
Giancarlo Comi
Carlo Pozzilli
Vincenzo Brescia Morra
Antonio Bertolotto
Francesca Sangalli
Luca Prosperini
Antonio Carotenuto
Pietro Iaffaldano
Marco Capobianco
Delia Colombo
Mihaela Nica
Sara Rizzoli
Maria Trojano
Publication date
01-10-2020
Publisher
Springer International Publishing
Published in
Neurological Sciences / Issue 10/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-020-04380-y

Other articles of this Issue 10/2020

Neurological Sciences 10/2020 Go to the issue