Effect of switching on the relapse rate measured as incidence rate ratio (IRR), using a Poisson regression model, after adjusting for baseline EDSS, disease duration and time on first-line disease modifying therapy.

<p>Within group comparison compares the relapse rate before and after the switch for each group. The between group comparison compares treatment effect on immunosuppressant and natalizumab groups with non-switchers or between natalizumab and immunosuppressants.</p

Diagram of charts reviewed.

<p>Diagram showing the total number of charts reviewed, the reason for exclusion and all included patients in the study. For those patients who switched to immunosuppressants, a detail of the immunosuppressant agents used is provided and for the non-switchers further detail is presented. *From the 99 identified patients, 4 were excluded from the statistical analyses due to missing information for important baseline characteristics.</p

Patients' characteristics.

†<p>Mean (±SD).</p>§<p>Median (range).</p><p>The annualized relapse rate (ARR) during the last year of treatment with first-line disease modifying therapy, as well as the ARR for the whole period on DMT and ARR after the switch. The time of follow-up after the switch is also presented for each patient group. SPMS: secondary progressive multiple sclerosis. DMT: disease modifying therapy. EDSS: expanded disability status scale.</p

Mean annualized relapse rate before and after the switch for each group.

<p>Bar plot showing the effect of switching therapy on the relapse rate within group. The model is adjusted for baseline EDSS, disease duration and time on first-line disease modifying therapy. Bars indicate 95% CI for the mean annualized relapse rate. Non-switchers: n = 13, Natalizumab: n = 60, Immunosuppressants, n = 22. * Statistically significant.</p