{
  "abstract": "Background Head-to-head randomised trials or real-world studies comparing the safety and efficacy of natalizumab and anti-CD20 monoclonal antibodies are limited. This study aimed to compare the effectiveness and safety of natalizumab versus ocrelizumab/rituximab in a real-world cohort of relapsing-remitting multiple sclerosis (RRMS) patients using data from the Middle East and North Africa Committee for the Treatment and Research in Multiple Sclerosis (MENACTRIMS) registry.Methods This registry-based, retrospective, multicentre study was carried out in seven Middle Eastern countries by analysing data from the MENACTRIMS registry. All adults RRMS patients treated with natalizumab, rituximab or ocrelizumab and maintained on treatment for at least 12 months were included. Patients were matched using propensity scores. Primary outcomes were annualised relapse rate (ARR), confirmed disability progression and improvement and MRI activity.Results A total of 1954 patients met the inclusion criteria, with 1277 receiving anti-CD20 therapy (768 on rituximab and 509 on ocrelizumab) and 677 natalizumab. Natalizumab significantly reduced ARR compared with anti-CD20 therapies (0.062 vs 0.092, p=0.001). Confirmed disability progression rates, MRI outcomes and no evidence of disease activity (NEDA-3) were similar between the two groups. However, natalizumab demonstrated higher rates of disability improvement compared with anti-CD20 therapies (9.3% vs 5.5%, p=0.03). Adverse events were more frequent in the anti-CD20 group (36.4% vs 27.5% for natalizumab, p=0.001).Conclusion In this large, real-world cohort, natalizumab was associated with lower ARR, greater likelihood of disability improvement, lesser adverse events, but lower persistence compared with anti-CD20 therapies. These findings provide valuable insights into the comparative efficacy and safety of these RRMS therapies, aiding clinicians in personalised treatment decisions.",
  "authors": [
    {
      "affiliations": [
        "Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE"
      ],
      "name": "Bassem Yamout"
    },
    {
      "affiliations": [
        "Amiri Hospital, Kuwait City, Kuwait"
      ],
      "name": "Raed Alroughani"
    },
    {
      "affiliations": [
        "Neurology, Ibn Sina Hospital, Kuwait City, Kuwait"
      ],
      "name": "Samar Frouk Ahmed Mohamed"
    },
    {
      "affiliations": [
        "Baghdad Medical City Teaching Hospital, Baghdad, Iraq"
      ],
      "name": "Akram M Al-Mahdawi"
    },
    {
      "affiliations": [
        "Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon"
      ],
      "name": "Samia Joseph Khoury"
    },
    {
      "affiliations": [
        "Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon"
      ],
      "name": "Nabil El Ayoubi"
    },
    {
      "affiliations": [
        "MS Department, Rashid Hospital and Dubai Medical College, Dubai Helath authority, Dubai, UAE"
      ],
      "name": "Jihad Inshasi"
    },
    {
      "affiliations": [
        "Department of Neurology, The Royal Hospital, Muscat, Oman"
      ],
      "name": "Jabir Alkhaboori"
    },
    {
      "affiliations": [
        "Neurology Unit, Department of Medicine, College of Medicine and Health Sciences and Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman"
      ],
      "name": "Abdullah Al-Asmi"
    },
    {
      "affiliations": [
        "Department of Neurology, Razi Hospital, Faculty of Medicine of Tunis, University Tunis el Manar, Manouba, Tunisia"
      ],
      "name": "Riadh Gouider"
    },
    {
      "affiliations": [
        "King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Salman Aljarallah"
    },
    {
      "affiliations": [
        "King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia"
      ],
      "name": "Nuha Alkhawajah"
    },
    {
      "affiliations": [
        "College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia",
        "Department of Neurology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Yaser Al Malik"
    },
    {
      "affiliations": [
        "College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia",
        "Department of Neurology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia",
        "King Abdullah International Medical Research Center, Riyadh, Saudi Arabia"
      ],
      "name": "Ahmad Abulaban"
    },
    {
      "affiliations": [
        "Department of Neurology, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia",
        "College of Medicine, King Saud bin Abdulaziz University for Health Sciences College of Applied Medical Sciences, Jeddah, Saudi Arabia",
        "King Abdullah International Medical Research Center, Jeddah, Saudi Arabia"
      ],
      "name": "Seraj Makkawi"
    },
    {
      "affiliations": [
        "Department of Neurology, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia",
        "College of Medicine, King Saud bin Abdulaziz University for Health Sciences College of Applied Medical Sciences, Jeddah, Saudi Arabia",
        "King Abdullah International Medical Research Center, Jeddah, Saudi Arabia"
      ],
      "name": "Osama Khojah"
    },
    {
      "affiliations": [
        "Lebanese University Faculty of Medical Sciences, Dekwaneh, Lebanon"
      ],
      "name": "Taghrid El-Hajj"
    },
    {
      "affiliations": [
        "Neurology Institute, Harley Street Medical Center, Abu Dhabi, UAE"
      ],
      "name": "Joelle Massouh"
    },
    {
      "affiliations": [
        "Al-Balqa Applied University Faculty of Medicine, As-Salt, Jordan"
      ],
      "name": "Husam AlSalamat"
    },
    {
      "affiliations": [
        "School of Pharmacy, Lebanese American University, Byblos, Lebanon"
      ],
      "name": "Hani Dimassi"
    },
    {
      "affiliations": [
        "Faculty of Pharmacy, Lebanese University, Hadath, Lebanon",
        "National Institute of Public Health, Clinical Epidemiology and Toxicology (INSPECT-LB), Beirut, Lebanon"
      ],
      "name": "Amal Al-Hajje"
    },
    {
      "affiliations": [
        "Faculty of Pharmacy, Lebanese University, Hadath, Lebanon",
        "National Institute of Public Health, Clinical Epidemiology and Toxicology (INSPECT-LB), Beirut, Lebanon",
        "School of Medicine, Lebanese American University, Byblos, Lebanon",
        "Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus"
      ],
      "name": "Pascale Salameh"
    },
    {
      "affiliations": [
        "Inserm U1094, IRD U270, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France"
      ],
      "name": "Farid Boumediene"
    },
    {
      "affiliations": [
        "School of Pharmacy, Lebanese American University, Byblos, Lebanon",
        "Inserm U1094, IRD U270, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France"
      ],
      "name": "Maya Zeineddine"
    }
  ],
  "title": "Comparative effectiveness of natalizumab and anti-CD20 monoclonal antibodies in relapsing-remitting multiple sclerosis: a real-world propensity-score matched study",
  "uid": "2cb7403d-1e6f-5397-9198-d887c393eca0"
}