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Comparative effectiveness of dimethyl fumarate as the initial and secondary treatment for MS
Department of Clinical Neuroscience, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, Sweden.
Department of Neuroscience, Uppsala University, Uppsala, Sweden.
Örebro University, School of Medical Sciences.
Department of Neuroscience, Uppsala University, Uppsala, Sweden.
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2019 (English)In: Multiple Sclerosis, ISSN 1352-4585, E-ISSN 1477-0970, article id 1352458519866600Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Population-based real-world evidence studies of the effectiveness and tolerability of dimethyl fumarate in relation to common treatment alternatives are still limited.

OBJECTIVE: To evaluate the clinical effectiveness and tolerability of dimethyl fumarate (DMF) as the initial and secondary treatment for relapsing-remitting multiple sclerosis (RRMS) patients compared with common treatment alternatives in Sweden.

METHODS:  We conducted a nationwide retrospective observational cohort study of all RRMS patients identified through the Swedish MS registry initiating DMF (n = 641) or interferons/glatiramer acetate (IFN/GA; n = 555) as the initial therapy, or DMF (n = 703) or fingolimod (FGL; n = 194) after switch from IFN/GA between 1 January 2014 and 31 December 2016.

RESULTS: The discontinuation rate was lower with DMF as the initial treatment than IFN/GA (adjusted hazard rate (HR): 0.46, 95% confidence interval (CI): 0.37-0.58, p < 0.001), but higher than FGL as the secondary treatment (HR: 1.51, CI: 1.08-2.09, p < 0.05). Annualized relapse rate (ARR) was lower with DMF compared to IFN/GA (0.04, CI: 0.03-0.06 vs 0.10, CI: 0.07-0.13; p < 0.05), but not FGL (0.03, CI: 0.02-0.05 vs 0.02, CI: 0.01-0.04; p = 0.41). Finally, time to first relapse (TTFR) was longer with DMF as the initial, but not secondary, therapy (p < 0.05 and p = 0.20, respectively).

CONCLUSION: Our findings indicate that DMF performs better than IFN/GA as the initial treatment for RRMS. Compared to FGL, DMF displayed a lower tolerability, but largely similar effectiveness outcomes.

Place, publisher, year, edition, pages
Sage Publications, 2019. article id 1352458519866600
Keywords [en]
Multiple sclerosis, dimethyl fumarate, fingolimod, glatiramer acetate, interferon-beta, relapsing-remitting
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Neurology
Identifiers
URN: urn:nbn:se:oru:diva-75814DOI: 10.1177/1352458519866600ISI: 000480888300001PubMedID: 31392923OAI: oai:DiVA.org:oru-75814DiVA, id: diva2:1345164
Note

Funding Agency:

Neuroförbundet, Stockholms Läns Landsting and Vetenskapsrådet 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-08-29Bibliographically approved

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Gunnarsson, Martin

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