Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis

Abstract

ObjectiveOral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed.MethodsWe identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring).ResultsThe eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68).ConclusionThe effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.

Oral therapies for treatment of relapsing–remitting multiple sclerosis in Austria: a 2-year comparison using an inverse probability weighting method

“…Comparable post-index ARR were observed between DMF and FTY, but were significantly lower with DMF versus TERI [16]. In contrast, Kalincik et al [17] showed a lower ARR on FTY compared with DMF and TERI analysing 614 (TERI), 782 (DMF) or 2332 (FTY) patients from the global MSBase cohort, staying at least 3 months on treatment. No differences in disability accumulation or improvement were found between these therapies.…”

“…The longer observation period on treatment (at least 24 months) produced more robust data especially in regards to disease progression and regression. patients Two previous studies also compared between these oral MS drugs [16,17]. Ontaneda et al, analysed patients from a commercial claims database, switching from platform disease-modifying therapies (DMTs) to DMF, FTY and TERI and staying on treatment for at least 3 months.…”

“…Studies matching the clinical efficacy provided conflicting results [9][10][11][12][13][14][15][16][17][18][19][20]. These discrepancies ask for further investigations to confirm or rebut the published findings, especially by real-life experiences.…”

Treatment in childhood central nervous system demyelinating disorders

“…A recent retrospective study comparing three drugs: fingolimod, dimethyl fumarate, and teriflunomide, in 3728 adult patients demonstrated a lower annual relapse rate (ARR) in the fingolimod group, but no difference in accumulation or improvement in disability compared to other groups. Comparison between dimethyl fumarate and teriflunomide for same parameters indicated no difference either …”

“…Comparison between dimethyl fumarate and teriflunomide for same parameters indicated no difference either. 13…”