Natalizumab has been generally considered among the most effective treatments for relapsing-remitting multiple sclerosis.
Rituximab was found more effective than fingolimod in the prevention of relapses among patients with highly active multiple sclerosis, according to a study in the Annals of Neurology.
The study included 256 patients with John Cunningham virus (JCV), which is present in nearly 50% of the general population.
Under normal circumstances, JCV does not cause a lot of problems for patients, however, it can cause progressive multifocal leukoencephalopathy (PML).
PML is typically found in patients with immune deficiencies because of the disease itself or immunosuppressant drugs.
Currently, natalizumab is considered among the most effective treatments for relapsing-remitting multiple sclerosis, but is associated with an increased risk of PML.
“Termination of natalizumab treatment has also been suggested to be associated with a risk of rebound disease activity, making it difficult to manage switches in clinical practice,” said lead study author Fredrik Piehl.
During the study, 256 patients switched from taking natalizumab to either rituximab or fingolimod. The results showed that 1.8% of patients who switched to rituximab and 17.6% who switched to fingolimod had a clinical relapse within 1.5 years.
The gap in effectiveness was unable to be explained by the differences in baseline characteristics between the 2 groups, the researchers noted.