NATIONAL HARBOR, MD—In a real-world comparison in patients with multiple sclerosis (MS), dimethyl fumarate and fingolimod were associated with the largest reduction in unadjusted relapse rates after initiation of disease-modifying therapy (DMT), according to data presented at the 2016 CMSC Annual Meeting. In addition, dimethyl fumarate was associated with significantly fewer arrhythmias, compared with glatiramer acetate, interferon beta, and teriflunomide after initiation of DMT.
Real-world data on the comparative effectiveness of DMTs for MS management are limited. The goal of this study, led by Aaron Boster, MD, Systems Medical Chief of Neuroimmunology for OhioHealth in Columbus, Ohio, and his colleagues was to compare the annual relapse rate in patients initiating delayed-release dimethyl fumarate, glatiramer acetate, interferon beta, fingolimod, or teriflunomide.
For this investigation, researchers used data from the Truven MarketScan Claim database, which includes information from 80 million commercially insured people in the United States. Patients with MS between ages 18 and 64 who initiated a DMT of choice in 2013 were included in the study.
Aaron Boster, MD
Dr. Boster and his colleagues calculated arrhythmias based on the number of MS-related relapses within one year after DMT initiation and examined chronic disease burden and MS-related symptoms. Composite scores depended on the presence of 22 chronic conditions, including diabetes, peptic ulcer, liver disease, and cancer. The Poisson regression model was used to estimate adjusted incidence rate ratios of relapse rate. The researchers adjusted the data for demographic and clinical characteristics such as age, sex, region, and place of residence.
The most significant decreases in unadjusted relapse rate were among patients receiving dimethyl fumarate or fingolimod. Dimethyl fumarate was associated with a lower number of arrhythmias, compared with other DMTs. Overall, patients initiating dimethyl fumarate or fingolimod were more adherent to treatment than patients receiving teriflunomide, glatiramer acetate, or interferon beta in the first year after DMT initiation. “Insights provided by real-world data, and the implications for differences in real-world comparative effectiveness of available DMTs, should be taken into account when making decisions on appropriate therapy for the management of MS,” said Dr. Boster and colleagues.
Some limitations of the study were that the data were not collected specifically for clinical research and that the results that did not provide certain clinical information required to assess disease severity properly.
—Erica Robinson