The efficacy of natalizumab in patients with relapsing multiple sclerosis: subgroup analyses of AFFIRM and SENTINEL.
Calabresi, Peter A
Galetta, Steven L
Lublin, Fred D
Miller, David H
O'Connor, Paul W
Phillips, J Theodore
Polman, Chris H
Rudick, Richard A
Stuart, William H
Wynn, Daniel R
Panzara, Michael A
AffiliationDept. of Neurology, St. Vincent's University Hospital, Dublin, Ireland., firstname.lastname@example.org
Antibodies, Monoclonal/*therapeutic use
Antibodies, Monoclonal, Humanized
Immunologic Factors/*therapeutic use
Multiple Sclerosis, Relapsing-Remitting/*drug therapy/pathology/physiopathology
Proportional Hazards Models
Severity of Illness Index
MetadataShow full item record
CitationJ Neurol. 2009 Mar;256(3):405-15. Epub 2009 Mar 18.
JournalJournal of neurology
AbstractThe AFFIRM and SENTINEL studies showed that natalizumab was effective both as monotherapy and in combination with interferon beta (IFNbeta)-1a in patients with relapsing multiple sclerosis (MS). Further analyses of AFFIRM and SENTINEL data were conducted to determine the efficacy of natalizumab in prespecified patient subgroups according to baseline characteristics: relapse history 1 year before randomization (1, 2, > or = 3), Expanded Disability Status Scale score (< or = 3.5, > 3.5), number of T2 lesions (< 9, > or = 9), presence of gadolinium-enhancing (Gd+) lesions (0, > or = 1), age (< 40, > or = 40) and gender (male, female). A post hoc analysis was conducted to determine the efficacy of natalizumab in patients with highly active disease (i. e., > or = 2 relapses in the year before study entry and > or = 1 Gd+ lesion at study entry). In both AFFIRM and SENTINEL studies natalizumab reduced the annualized relapse rates across all subgroups (except the small subgroups with < 9 baseline T2 lesions) over 2 years. In AFFIRM, natalizumab significantly reduced the risk of sustained disability progression in most subgroups. In SENTINEL, natalizumab significantly reduced the risk of sustained disability progression in the following subgroups: > or = 9 T2 lesions at baseline, > or = 1 Gd+ lesions at baseline, female patients and patients < 40 years of age. Natalizumab reduced the risk of disability progression by 64 % and relapse rate by 81 % in treatment- naive patients with highly active disease and by 58 % and 76 %, respectively, in patients with highly active disease despite IFNbeta-1a treatment. These results indicate that natalizumab is effective in reducing disability progression and relapses in patients with relapsing MS, particularly in patients with highly active disease.
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