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Comparative effectiveness of teriflunomide and dimethyl fumarate: A nationwide cohort study

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@article{e08911285903445b96cc33e02288e1ff,
title = "Comparative effectiveness of teriflunomide and dimethyl fumarate: A nationwide cohort study",
abstract = "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.",
author = "Buron, {Mathias Due} and Chalmer, {Thor Ameri} and Finn Sellebjerg and Jette Frederiksen and G{\'o}ra, {Monika Katarzyna} and Zsolt Illes and Matthias Kant and Zsolt Mezei and Thor Petersen and Rasmussen, {Peter Vestergaard} and Homayoun Roshanisefat and Houry Hassanpour-Kalam-Roudy and Tobias Sejb{\ae}k and Anna Tsakiri and Arkadiusz Weglewski and Sorensen, {Per Soelberg} and Melinda Magyari",
note = "{\circledC} 2019 American Academy of Neurology.",
year = "2019",
doi = "10.1212/WNL.0000000000007314",
language = "English",
volume = "92",
pages = "e1811--e1820",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams & Wilkins",
number = "16",

}

RIS

TY - JOUR

T1 - Comparative effectiveness of teriflunomide and dimethyl fumarate

T2 - A nationwide cohort study

AU - Buron, Mathias Due

AU - Chalmer, Thor Ameri

AU - Sellebjerg, Finn

AU - Frederiksen, Jette

AU - Góra, Monika Katarzyna

AU - Illes, Zsolt

AU - Kant, Matthias

AU - Mezei, Zsolt

AU - Petersen, Thor

AU - Rasmussen, Peter Vestergaard

AU - Roshanisefat, Homayoun

AU - Hassanpour-Kalam-Roudy, Houry

AU - Sejbæk, Tobias

AU - Tsakiri, Anna

AU - Weglewski, Arkadiusz

AU - Sorensen, Per Soelberg

AU - Magyari, Melinda

N1 - © 2019 American Academy of Neurology.

PY - 2019

Y1 - 2019

N2 - 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.

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.

U2 - 10.1212/WNL.0000000000007314

DO - 10.1212/WNL.0000000000007314

M3 - Journal article

VL - 92

SP - e1811-e1820

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 16

ER -

ID: 57586478