36 When comparing natalizumab and fingolimod, the proportion of patients with NEDA-3 was greater for natalizumab than fingolimod in the first dataset, whereas in the second, the difference did not reach statistical significance, probably due in part to the smaller size of that cohort. 36 A systematic review and meta-analysis of highly active rMS and rapidly evolving severe MS explored the efficacy of fingolimod relative to DMF and natalizumab. 37 In the highly active relapsing–remitting multiple sclerosis (RRMS) population, a trend favoured fingolimod over DMF in reducing the ARR and confirmed disability progression.
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