Dimethyl fumarate vs Teriflunomide: an Italian time-to-event data analysis

Abstract

BackgroundThe introduction of oral disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) changed algorithms of RRMS treatment. ObjectivesTo compare effectiveness of treatment with dimethyl fumarate (DMF) and teriflunomide (TRF) in a large multicentre Italian cohort of RRMS patients. Materials and MethodsPatients with RRMS who received treatment with DMF and TRF between January 1 st , 2012 and December 31 th , 2018 from twelve MS centers were identified. The events investigated were "time-to-first-relapse", "time-to-Magnetic-Resonance-Imaging (MRI)-activity" and "time-to-disability-progression".Results 1,445 patients were enrolled (1,039 on DMF, 406 on TRF) and followed for a median of 34 months. Patients on TRF were older (43.5±8.6 vs 38.8±9.2 years), with a predominance of men and higher level of disability (p<0.001 for all). Patients on DMF had a higher number of relapses and radiological activity (p<.05) at baseline. Time-varying Cox-model for the event "time-to-first relapse" revealed that patients on DMF have a lower relapse-hazard before 38 months of treatment (HRt<38DMF=0.73, CI=0.52-1.03, p<.005). When the time-on-therapy exceeds 38 months, the relapse hazard for DMF patients increase (HRt>38DMF=3.83, CI= 0.89-1.02, p<.005). Both DMTs controlled similarly MRI activity and disability progression. Conclusions Patients on DMF had higher relapse free survival time than TRF group during the first 38 months on therapy.

Beliefs about medication as predictors of medication adherence in a prospective cohort study among persons with multiple sclerosis

“…There is widespread recognition that adherence to medication is key to successful health care of persons with Multiple Sclerosis (PwMS) [1][2][3][4][5] yet reviews on diseasemodifying therapies (DMT) medication-taking among PwMS estimate adherence as ranging between 41 and 88% [1] and persistence ranging from 16 to 27% [2]. Adherence is especially challenging to PwMS taking DMTs.…”

Real-world discontinuation rate of teriflunomide and dimethyl fumarate in multiple sclerosis

“…9 In a time-to-event study, a lower risk of relapses after 38 months was found for dimethyl fumarate in comparison with teriflunomide. 18 A cumulative incidence of discontinuation because of disease breakthrough of 22% for teriflunomide users versus 11% for dimethyl fumarate users has also recently been reported. 10 The latter study also found that patients using dimethyl fumarate had a 23% lower hazard of relapsing.…”

Injectable Versus Oral First-Line Disease-Modifying Therapies: Results from the Italian MS Register

“…Established efficacy evidence for reducing relapsing activity and disability progression is available for all licensed firstline DMTs, but the need for real data of comparison between the established and the newer first-line DMTs in unselected patient populations is still needed to define treatment sequences and to gather real-world data on long-term outcomes [8][9][10][11][14][15][16][17][18][19].…”

“…In the last several years, the Italian MS Register, the largest national clinical database with about 140 Italian MS centers, offered the opportunity to study real-world clinical outcomes in large cohorts of patients to represent daily clinical practice [18,20].…”

“…The aim of the current study was to evaluate long-term outcomes of first-line DMTs in terms of time to first relapse, time to confirmed disability progression (CDP), and, additionally, time to discontinuation in RRMS-naïve patients by focusing on the direct comparison between injectable and oral first-line DMTs, namely interferons and glatiramer acetate compared to dimethyl fumarate and teriflunomide [18].…”