RT Journal Article
SR Electronic
T1 Comparative effectiveness of teriflunomide and dimethyl fumarate
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1811
OP e1820
DO 10.1212/WNL.0000000000007314
VO 92
IS 16
A1 Buron, Mathias Due
A1 Chalmer, Thor Ameri
A1 Sellebjerg, Finn
A1 Frederiksen, Jette
A1 Góra, Monika Katarzyna
A1 Illes, Zsolt
A1 Kant, Matthias
A1 Mezei, Zsolt
A1 Petersen, Thor
A1 Rasmussen, Peter Vestergaard
A1 Roshanisefat, Homayoun
A1 Hassanpour-Kalam-Roudy, Houry
A1 Sejbæk, Tobias
A1 Tsakiri, Anna
A1 Weglewski, Arkadiusz
A1 Sorensen, Per Soelberg
A1 Magyari, Melinda
YR 2019
UL http://n.neurology.org/content/92/16/e1811.abstract
AB Objective To compare on-treatment efficacy and discontinuation outcomes in teriflunomide (TFL) and dimethyl fumarate (DMF) in the treatment of relapsing-remitting multiple sclerosis (RRMS) in a real-world setting.Methods We identified all patients starting TFL or DMF from the Danish Multiple Sclerosis Registry and compared on-treatment efficacy outcomes between DMF using TFL, adjusted for clinical baseline variables and propensity score-based methods.Results We included 2,236 patients in the study: 1,469 patients on TFL and 767 on DMF. Annualized relapse rates (ARRs) in TFL and DMF were 0.16 (95% confidence interval [CI] 0.13–0.20) and 0.09 (95% CI 0.07–0.12), respectively. Relapse rate ratio for DMF/TFL was 0.58 (95% CI 0.46–0.73, p < 0.001). DMF had a higher relapse-free survival proportion at 48 months of follow-up (p < 0.05). We observed no difference in Expanded Disability Status Scale score worsening. Discontinuations due to disease breakthrough were 10.2% (95% CI 7.6%–12.8%) and 22.1% (95% CI 19.2%–25.0%) for DMF and TFL, respectively. A subgroup analysis of ARRs in 708 patients with available baseline MRI T2 lesion amount reported similar results after adjustment.Conclusion We found lower ARR, higher relapse-free survival, and lower incidence of discontinuation due to disease breakthrough on treatment with DMF compared with TFL.Classification of evidence This study provides Class II evidence that for patients with RRMS, DMF is more effective in preventing relapses and has lower discontinuation due to disease breakthrough compared with TFL.ARR=annualized relapse rate; CI=confidence interval; CONFIRM=Comparator and an Oral Fumarate in Relapsing–Remitting Multiple Sclerosis; DEFINE=Determination of the Efficacy and Safety of Oral Fumarate in Relapsing–Remitting MS; DMF=dimethyl fumarate; DMSR=Danish Multiple Sclerosis Registry; DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; IPTW=inverse probability of treatment weights; MS=multiple sclerosis; OR=odds ratio; RRMS=relapsing-remitting multiple sclerosis; TEMSO=Teriflunomide Multiple Sclerosis Oral; TFL=teriflunomide; TOWER=An Efficacy Study of Teriflunomide in Participants With Relapsing Multiple Sclerosis