VANCOUVER, BC—In a real-world efficacy study comparing disease modifying therapies (DMT) for multiple sclerosis (MS), delayed-release dimethyl fumarate (DMF) was associated with the largest decrease in unadjusted relapse rates after initiation, reported Aaron Boster, MD, Riverside Methodist Hospital, Columbus, OH, at the 68th AAN Annual Meeting.

Real-world outcomes are important in understanding the therapeutic efficacy but current data on comparative efficacy of DMTs for MS in routine clinical practice are limited. Dr. Boster and colleagues set out to compare annualized relapse rates (ARR) and DMT adherence for MS patients initiating DMF, interferon-β (IFN-β), glatiramer acetate, teriflunomide or fingolimod in routine practice. Data were collected from Truven MarketScan databases between January 2012 and September 2014 for adults with MS who initiated an oral or injectable DMT. They assessed baseline clinical characteristics based on claims within the 1 year pre-index period and included chronic disease burden and MS-related symptoms. 

The study’s primary outcome, ARR, was measured based on the number of MS-related relapses within 1 year after initiating DMT; ARRs were compared both pre- and post-DMT initiation for each cohort. Index DMT adherence was measured using proportion of days covered (PDC) within the 1 year after initiation.

The data indicated that the DMF cohort (n=2,564) had the largest reduction in unadjusted ARR from 0.43 to 0.29 (P<0.0001). The next greatest ARR reduction was observed in the fingolimod cohort (n=461) from 0.45 to 0.33 (P=0.0016). 

After adjusting for patient demographics, clinical characteristics, and prior DMT exposure, DMF was associated with significantly lower ARR than the other evaluated therapies: glatiramer acetate (0.28 to 0.31, n=827), IFN-β (0.37 to 0.34, n=735), and teriflunomide (0.41 to 0.37, n=417). “No significant difference was found between the dimethyl fumarate and fingolimod cohorts,” noted Dr. Boster.

Relative to the DMF cohort, the adjusted incidence rate ratio of ARR in 1 year after DMT initiation was 1.28 (95% CI: 1.10–1.48) for glatiramer acetate, 1.25 (95% CI: 1.08–1.45) for IFN-β, 1.12 (95% CI: 0.94–1.33) for fingolimod, and 1.28 (95% CI: 1.08–1.53) for teriflunomide. 

The real-world efficacy data of evaluated DMTs were consistent with prior mixed and indirect treatment comparisons though there were differences in baseline patient demographics and comorbidities between the clinical trial sample and the U.S. claims data. 

Dr. Boster noted that healthcare professionals should “be aware of the importance of real-world data, and of the differences in real-world comparative effectiveness of available DMTs, when making decisions and when consulting with patients on appropriate therapy for the management of MS.”

Dr. Boster has received compensation from Biogen, and the other researchers have also received compensation, or are employees of Biogen.