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Background <p>Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system, predominantly presenting as relapsing–remitting MS. Fingolimod decreases relapse rates by lymphocyte sequestration, yet persistent activity often requires switching to B cell–depleting therapies (BCDTs) such as ocrelizumab (OCR) or rituximab (RTX). Data on outcomes after this switch remain limited.</p> Methods <p>We searched MEDLINE, Embase, and Cochrane Library databases. Single-arm rates were pooled via weighted meta-analysis; continuous outcomes by mean differences (MD), both with 95% confidence interval (C.I.). Significance was set at <i>P</i> &lt; 0.05, and heterogeneity by <i>I</i><sup>2</sup>.</p> Results <p>Eleven retrospective cohort studies (<i>n</i> = 1084) of MS patients switching from fingolimod to BCDTs were included in this meta-analysis. A high relapse-free proportion after switching to BCDTs (90%; 95%C.I.: 86–94%; <i>I</i><sup>2</sup> = 74.2%) was observed. OCR demonstrated a relapse-free proportion of 91% (95%CI: 86–97%; <i>I</i><sup>2</sup> = 74.5%), while RTX had 81% (95%C.I. 74–89%; <i>I</i><sup>2</sup> = 26.4%). Relapses during washout occurred in 11% (95%CI: 6–17%; <i>I</i><sup>2</sup> = 91.9%): relapse proportion was 20% (95% CI 7–34%; <i>I</i><sup>2</sup> = 90.3%) after a long washout (&gt; 4&#xa0;weeks) and 0% (95% CI: 0–2%; <i>I</i><sup>2</sup> = 0%) after a short washout (&lt; 4&#xa0;weeks). Radiological activity–free proportion was 76% (95% CI 59–88%; <i>I</i><sup>2</sup> = 81.2%) overall BCDTs. Regarding Expanded Disability Status Scale, no significant change was observed after switching (MD − 0.845; 95%C.I. − 2.062–0.371; <i>P</i> = 0.173; <i>I</i><sup>2</sup> = 89.4%).</p> Conclusion <p>MS patients who switched from fingolimod to OCR or RTX maintained high rates of both clinical remission and radiological stability, and a washout shorter than four weeks virtually eliminated relapses—demonstrating robust efficacy for BCDTs in this subgroup.</p>

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Clinical outcomes after switching from fingolimod to B-cell-depleting therapies in multiple sclerosis: systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年7月30日

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  • Pedro Henrique de Souza Wagner,
  • Felipe Alves de Paiva,
  • Julia Scaramal Mello,
  • Anna Lydia Machado Silva,
  • Larissa Emi Tanimoto,
  • Fernanda Moraes Tamashiro,
  • Letícia Hanna Moura da Silva Gattas Graciolli,
  • Artur Menegaz de Almeida

摘要

Background

Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system, predominantly presenting as relapsing–remitting MS. Fingolimod decreases relapse rates by lymphocyte sequestration, yet persistent activity often requires switching to B cell–depleting therapies (BCDTs) such as ocrelizumab (OCR) or rituximab (RTX). Data on outcomes after this switch remain limited.

Methods

We searched MEDLINE, Embase, and Cochrane Library databases. Single-arm rates were pooled via weighted meta-analysis; continuous outcomes by mean differences (MD), both with 95% confidence interval (C.I.). Significance was set at P < 0.05, and heterogeneity by I2.

Results

Eleven retrospective cohort studies (n = 1084) of MS patients switching from fingolimod to BCDTs were included in this meta-analysis. A high relapse-free proportion after switching to BCDTs (90%; 95%C.I.: 86–94%; I2 = 74.2%) was observed. OCR demonstrated a relapse-free proportion of 91% (95%CI: 86–97%; I2 = 74.5%), while RTX had 81% (95%C.I. 74–89%; I2 = 26.4%). Relapses during washout occurred in 11% (95%CI: 6–17%; I2 = 91.9%): relapse proportion was 20% (95% CI 7–34%; I2 = 90.3%) after a long washout (> 4 weeks) and 0% (95% CI: 0–2%; I2 = 0%) after a short washout (< 4 weeks). Radiological activity–free proportion was 76% (95% CI 59–88%; I2 = 81.2%) overall BCDTs. Regarding Expanded Disability Status Scale, no significant change was observed after switching (MD − 0.845; 95%C.I. − 2.062–0.371; P = 0.173; I2 = 89.4%).

Conclusion

MS patients who switched from fingolimod to OCR or RTX maintained high rates of both clinical remission and radiological stability, and a washout shorter than four weeks virtually eliminated relapses—demonstrating robust efficacy for BCDTs in this subgroup.