Best-Ms: A Standardized And Prospective Study Comparing The Efficacy Of Natalizumab Versus Fingolimod In Active Relapsing Multiple Sclerosis.

Objective: To compare head to head the efficacy between natalizumab (NTZ) and fingolimod (FTY) in active relapsing-remitting multiple sclerosis (RRMS). Background: Therapeutic options are growing for active RRMS patients, but few prospective studies are available to compare their efficacy. Best Escalation Strategy in MS (BEST MS) started in France in 2013 when NTZ and FTY were the two most employed therapies in active RRMS. Design/Methods: BEST-MS is a French prospective multicentric study. Patients with active RRMS (defined as at least 1 relapse in the last 12 months on a well-conducted 1st line therapy with at least 9 T2 hyperintensities on MRI, OR at least 2 relapses in the last 12 months with evidence of active disease on MRI for naive patients) were enrolled to be treated either with NTZ or FTY. Treatment choice was at the discretion of the physician. Relapses, EDSS and brain MRI were collected at baseline and at 12 months. Results: 230 patients were included (mean age: 38.2 yrs, F/M: 3.1, FTY: 117, NTZ: 113). There was no statistical difference between groups regarding baseline clinical and radiological characteristics. At M12, NTZ indicated a better efficacy regarding new T2 lesions (0.7 vs 1.4, p=0.01) and gadolinium enhancing lesions (0.03 vs 0.5, p Conclusions: NTZ demonstrates higher efficacy than FTY on MRI in active RRMS patients. ARR is lower in favor of NTZ, and most relapses occurred early. Drop out is higher on FTY mostly due to adverse events. Disclosure: Dr. Cohen has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Roche, Merck, Ad Scientiam.Dr. Mondot has nothing to disclose. Dr. Bucciarelli has nothing to disclose. Dr. Pignolet has nothing to disclose. Dr. Laplaud has nothing to disclose. Dr. Brochet has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Received consultancy fees, speaker fees or honoraria from Novartis, Biogen-Idec, Merck KGaA, Roche and Cellgene. Dr. Brochet has received research support from Institution has received research grants (non-personal) and/or clinical trials contracts from Novartis, Biogen-Idec, Merck KGaA, Roche, Medday, Actelion and Genzyme Sanofi.. Dr. Defer has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Personal compensation for scientific advisory boards and funding for travel and/or speaker honoraria from Biogen, Merck-Serono, Novartis, Sanofi-Genzyme, Roche and Teva. Dr. Defer has received research support from Institutional research grants from Biogen, Merck-Serono, Novartis, Sanofi Genzyme. Dr. Derache has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Merck Serono, Biogen, Novartis, Teva, Sanofi-Genzyme. Dr. Vermersch has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Almirall, Biogen, Celgene, Merck Serono, Novartis, Roche, Sanofi, Servier, and Teva. Dr. Vermersch has received research support from Almirall, Biogen, Celgene, Merck Serono, Novartis, Roche, Sanofi, Servier, and Teva.Dr. Zephir has nothing to disclose. Dr. Debouverie has nothing to disclose. Dr. Berger has nothing to disclose. Dr. Labauge has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen,Sanofi-Genzyme, Bayer, Novartis, Teva, Merck-Serono, Roche and Medday.. Dr. Labauge has received research support from Biogen, Novartis, Sanofi-Genzyme, Roche and Medday.. Dr. Ayrignac has nothing to disclose. Dr. De Seze has nothing to disclose. Dr. Brassat has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bayer, Biogen, Medday, Merck, Novartis, Roche, Sanofi-Genzyme, Teva. Dr. Brassat has received research support from Novartis, Medday Pharmaceutical. Dr. Lebrun-Frenay has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Consulting fees, honoraria or scientific committee support: Bayer Schering, Biogen, Genzyme, Merck Serono, Novartis, Teva.