Department of Neurology, Oslo University Hospital, Oslo, Norway.
Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Mult Scler Relat Disord. 2022 Jun;62:103812. doi: 10.1016/j.msard.2022.103812. Epub 2022 Apr 17.
A sudden onset of extensive disease activity, including severe clinical relapse and extensive brain or spinal magnetic resonance imaging (MRI) lesions, termed "rebound" disease activity has been reported after withdrawal of fingolimod in patients with multiple sclerosis (MS).
To compare the risk of rebound after switching from fingolimod to cladribine or rituximab in MS.
All patients switching from fingolimod to cladribine or rituximab were included in a retrospective cohort study utilizing prospectively collected data from two university hospitals with different treatment strategies.
A total of 73 patients with at least 6 months follow-up after switching were identified, 33 patients had switched from fingolimod to cladribine and 40 patients to rituximab. No patients in the rituximab group and seven (21.1%) in the cladribine group qualified for rebound disease activity. Ten (30.3%) of the patients using cladribine and five (12.5%) of the patients using rituximab experienced a relapse. MRI disease activity was seen in 18 (54.5%) and eight (20.0%) of the patients using cladribine and rituximab, respectively. Younger age and previous high relapse rate were associated with increased risk of rebound in the cladribine group.
We identify a lower risk of rebound during the first year after switching from fingolimod to rituximab compared to cladribine, indicating a better initial clinical outcome with the former treatment strategy.
在多发性硬化症（MS）患者停用 fingolimod 后，会出现广泛疾病活动的突然发作，包括严重的临床复发和广泛的脑或脊髓磁共振成像（MRI）病变，称为“反弹”疾病活动。
比较多发性硬化症患者从 fingolimod 转换为 cladribine 或 rituximab 后反弹的风险。
在一项回顾性队列研究中，纳入了所有从 fingolimod 转换为 cladribine 或 rituximab 的患者，该研究利用了两所大学医院前瞻性收集的不同治疗策略的数据。
共确定了 73 名至少随访 6 个月的患者，其中 33 名患者从 fingolimod 转换为 cladribine，40 名患者转换为 rituximab。rituximab 组无患者符合反弹疾病活动标准， cladribine 组有 7 名（21.1%）符合。使用 cladribine 的 10 名（30.3%）和使用 rituximab 的 5 名（12.5%）患者出现复发。使用 cladribine 和 rituximab 的患者分别有 18 名（54.5%）和 8 名（20.0%）患者出现 MRI 疾病活动。 cladribine 组中，年龄较小和既往高复发率与反弹风险增加相关。
与 cladribine 相比，从 fingolimod 转换为 rituximab 后的第一年，反弹的风险较低，表明前者的初始临床结局更好。
