Oral Combination Therapies for MS Offer Superior Effectiveness

By Annette M. Boyle

The first retrospective comparison of newer oral disease-modifying therapies (DMTs) to injectable DMTs for relapsing-remitting multiple sclerosis (MS) found that, in real-world settings, patients taking two of the oral drugs had lower relapse rates in the year following initiation of treatment than patients on the injectable agents.

That offers good news for the 17,000 veterans who receive care through the VA, as the oral medications provide greater convenience, eliminate the need for frequent injections and often improve adherence.

The study, published in Neurology and Therapy, compared the oral therapies dimethyl fumarate, fingolimod and teriflunomide to the injectables interferon beta and glatiramer acetate using the Truven MarketScan Commercial Claims Databases from 2012 to 2014. The database included 14,854 individuals with MS who initiated a new DMT in 2013. Of those, the study focused on the 6,372 who had continuous enrollment one year before and one year after the index date.1

Unadjusted annualized relapse rates for 1 year before and 1 year after DMT initiation. DMT disease-modifying therapy

The researchers determined the number of relapse episodes patients had in the year before and the year following initiation of one of the five studies DMTs. Moderate-to-severe relapses included those that required hospitalization with a primary diagnosis of MS or an outpatient visit coded for MS that was combined with receipt of a high-dose steroid or plasma exchange within 30 days of the visit. All visits or hospitalizations in a 30 day period were classified as a single episode.

Of the 6,372 patients in the study, 52.6% started DMF, 13.9% began interferon beta, 7.8% started teriflunomide and 9.1% initiated fingolimod. Between 76% and 80% of the patients initiating each DMT were female. Patients starting glatiramer acetate and interferon beta had the highest mean Charlson Comorbidity Index scores (CCIs) at 0.76 and 0.71, respectively. Those starting on oral DMTs had lower CCIs with those initiating fingolimod the lowest at 0.42, followed by dimethyl fumarate at 0.52 and teriflunomide at 0.65.

Unadjusted annual relapse rates (ARR) in the year before the start of the new therapy were 0.31 for patients initiating glatiramer acetate, 0.37 for those starting interferon beta, 0.38 for teriflunomide, 0.43 for dimethyl fumarate and 0.44 for fingolimod. In the year following initiation, annual relapse rates dropped the most for dimethyl fumarate and fingolimod, both by about 0.13. Patients starting glatiramer acetate had higher annual rates of relapse following initiation (+0.02), while those on teriflunomide and interferon beta had slight declines (-0.03).

Fingolimod and dimethyl fumarate had the highest increases in the percentage of patients who experienced no relapses for the 12 months following therapy initiation, 11.6% and 8.1%, respectively. The interferon beta group had a 5.9% increase in the rate of no relapses, while glatiramer acetate rates rose 2.9% and the teriflunomide group saw an increase of 6.2%.

“Our results indicate that there are significant differences in the effectiveness of the different DMTs in patients with MS,” concluded the authors. “These data should assist in treatment decisions regarding the choice of DMT and enable clinicians to consider both real-world effectiveness and route of administration in consultations with their patients.”

  1. Boster A, Nicholas J, Wu N, Yeh WS, Fay M, Edwards M, Huang MY, Lee A. Comparative Effectiveness Research of Disease-Modifying Therapies for the Management of Multiple Sclerosis: Analysis of a Large Health Insurance Claims Database. Neurol Ther. 2017 Feb 16. doi: 10.1007/s40120-017-0064-x. [Epub ahead of print]

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