Comparative effectiveness of dimethyl fumarate versus non-specific immunosuppressants: Real-world evidence from MSBase

Background The use of non-specific immunosuppressants (NSIS) to treat multiple sclerosis (MS) remains prevalent in certain geographies despite safety concerns, likely due to resource limitations. Objective To use MSBase registry data to compare real-world outcomes in adults with relapsing-remitting...

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Published in:	Multiple sclerosis journal - experimental, translational and clinical Vol. 10; no. 2; p. 20552173241247182
Main Authors:	Spelman, Tim, Eichau, Sara, Alroughani, Raed, Ozakbas, Serkan, Khoury, Samia J, Patti, Francesco, Kubala Havrdova, Eva, Boz, Cavit, Terzi, Murat, Kuhle, Jens, Grammond, Pierre, Lechner-Scott, Jeanette, Gray, Orla, Amato, Maria Pia, Laureys, Guy, Shaygannejad, Vahid, Hyde, Robert, Wang, Haijue, Bozin, Ivan, Belviso, Nicholas, Quan, Chao, Zeng, Feng, van der Walt, Anneke, Butzkueven, Helmut
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-04-2024 Sage Publications Ltd
Subjects:	Immunosuppressive agents Original effectiveness real-world non-specific immunosuppressants Dimethyl fumarate relapsing-remitting multiple sclerosis
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Summary:	Background The use of non-specific immunosuppressants (NSIS) to treat multiple sclerosis (MS) remains prevalent in certain geographies despite safety concerns, likely due to resource limitations. Objective To use MSBase registry data to compare real-world outcomes in adults with relapsing-remitting MS (RRMS) treated with dimethyl fumarate (DMF) or NSIS (azathioprine, cyclosporine, cyclophosphamide, methotrexate, mitoxantrone or mycophenolate mofetil) between January 1, 2014 and April 1, 2022. Methods Treatment outcomes were compared using inverse probability of treatment weighting (IPTW) Cox regression. Outcomes were annualized relapse rates (ARRs), time to discontinuation, time to first relapse (TTFR) and time to 24-week confirmed disability progression (CDP) or 24-week confirmed disability improvement (CDI; in patients with baseline Expanded Disability Status Scale [EDSS] score ≥2). Results After IPTW, ARR was similar for DMF (0.13) and NSIS (0.16; p = 0.29). There was no difference in TTFR between cohorts (hazard ratio [HR]: 0.98; p = 0.84). The DMF cohort experienced longer times to discontinuation (HR: 0.75; p = 0.001) and CDP (HR: 0.53; p = 0.001), and shorter time to CDI (HR: 1.99; p < 0.008), versus the NSIS cohort. Conclusion This analysis supports the use of DMF to treat patients with relapsing forms of MS, and may have implications for MS practices in countries where NSIS are commonly used to treat RRMS.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2055-2173 2055-2173
DOI:	10.1177/20552173241247182