Butzkueven H, Licata S, Jeffery D, et al. - In patients with active relapsing-remitting multiple sclerosis, researchers directly compared the effectiveness of natalizumab and fingolimod in this phase 4, randomised, rater- and sponsor-blinded, prospective, parallel-group, clinic-based head-to-head study. This investigation was carried out at 43 sites in nine countries where study participants were randomised (1:1) to intravenous natalizumab 300 mg every 4 weeks or oral fingolimod 0.5 mg once daily for ≤ 52 weeks. The intent-to-treat population consisted of 108 patients (natalizumab, n = 54; fingolimod, n = 54), and 63 completed ≥ 24 weeks of treatment. The findings indicate a greater advantage with natalizumab than with fingolimod in the reduction of relapse rates and T1 Gd+ lesion accumulation in patients with active RRMS. The onset of efficacy was more rapid with natalizumab vs fingolimod; in patients with active disease who require fast and efficient control of disease activity, this may be an important factor for treatment selection.