Comparison of the efficacy of fingolimod and ocrelizumab treatments, which are second-line treatments, in patients diagnosed with relapsing remitting multiple sclerosis

Introduction and Objective: Multiple Sclerosis (MS) is a chronic disease characterized by demyelination and neuronal damage in the central nervous system and is the most common cause of non-traumatic disability in young adults. It is classified into Relapsing Remitting Multiple Sclerosis (RRMS) and Progressive MS according to clinical phenotypes. The most common initial phenotype is RRMS. In the treatment of MS, disease modifying drugs (DMDs) aim to reduce the frequency of attacks and delay progression. There are many DMDs used in the treatment of RRMS. Fingolimod and Ocrelizumab are DMDs used as second-line treatment in our country. In this study, we aimed to compare the efficacy of Fingolimod and Ocrelizumab in RRMS patients. Materials and Methods: The study was planned as retrospective and observational. The study included 89 patients in the Fingolimod group and 85 patients in the Okrelizumab group who were followed up with a diagnosis of RRMS in the Demyelinating Diseases outpatient clinic of the Department of Neurology, Çukurova University Faculty of Medicine Hospital. Inclusion criteria were as follows: age of 18 years or older, use of either Fingolimod or Ocrelizumab for at least 1 year, EDSS (Expanded Disability Status Scale) value of 0-6. Age, disease duration, number of attacks in the last year before treatment, EDSS value, magnetic resonance imaging (MRI) activity data were obtained from files of the patients. The primary objective of the study was to compare the annual attack rate, the proportion of attack free patient and the time to first attack after treatment. The secondary objective was to compare the increase in disability and MRI activity after treatment. For this purpose, the 1 year and 2 year treatment period after the initiation of Fingolimod or Okrelizumab was analyzed. Post-treatment data were obtained from patient files and clinical follow-ups. IBM SPSS V23 program was used for statistical evaluation. Results: There was no statistically significant difference between Fingolimod and Ocrelizumab in terms of the rate of attack-free patients, annual attack rate and time to first attack in the 1st year and 2nd year after treatment. The annual change in EDSS value at the end of the 1st year and 2nd year after treatment did not show a statistically significant difference between the two groups. There was no statistically significant difference between the groups in terms of clinical progression and MRI activity at 1 year and 2 years after treatment. After 1 year, the rate of treatment discontinuation due to clinical activation/progression and/or MRI activity was higher in the Fingolimod group than in the Ocrelizumab group. Conclusion: Fingolimod and Ocrelizumab treatments seem to be similarly effective in preventing attacks, reducing the annual attack rate, EDSS change and MRI activity in RRMS patients. However, further prospective and long-term studies with larger patient groups are needed to confirm these findings and to obtain more definitive results. Keywords: Multiple Sclerosis, Relapsing Remitting Multiple Sclerosis, Fingolimod, Ocrelizumab, Efficacy