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Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis
T. Kalincik, E. Kubala Havrdova, D. Horakova, G. Izquierdo, A. Prat, M. Girard, P. Duquette, P. Grammond, M. Onofrj, A. Lugaresi, S. Ozakbas, L. Kappos, J. Kuhle, M. Terzi, J. Lechner-Scott, C. Boz, F. Grand'Maison, J. Prevost, P. Sola, D....
Language English Country Great Britain
Document type Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't
NLK
ProQuest Central
from 1944-07-01 to 6 months ago
Nursing & Allied Health Database (ProQuest)
from 1944-07-01 to 6 months ago
Health & Medicine (ProQuest)
from 1944-07-01 to 6 months ago
Psychology Database (ProQuest)
from 1944-07-01 to 6 months ago
- MeSH
- Dimethyl Fumarate therapeutic use MeSH
- Adult MeSH
- Fingolimod Hydrochloride therapeutic use MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Cohort Studies MeSH
- Crotonates therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Proportional Hazards Models MeSH
- Recurrence MeSH
- Multiple Sclerosis, Relapsing-Remitting drug therapy physiopathology MeSH
- Propensity Score MeSH
- Toluidines therapeutic use MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
OBJECTIVE: Oral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed. METHODS: We identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring). RESULTS: The eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68). CONCLUSION: The effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.
Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino Avellino Italy
Central Clinical School Monash University Melbourne Victoria Australia
CISSS de Chaudière Appalaches Levis Quebec Canada
Cliniques Universitaires Saint Luc Université Catholique de Louvain Brussels Belgium
CSSS Saint Jérôme Saint Jerome Quebec Canada
Department of Basic Medical Sciences Neuroscience and Sense Organs University of Bari Bari Italy
Department of Neuroscience Azienda Ospedaliera Universitaria Modena Italy
Department of Neuroscience Imaging and Clinical Sciences University G d'Annunzio Chieti Italy
Division of Neurology Department of Medicine Amiri Hospital Sharq Kuwait
Dokuz Eylul University Izmir Turkey
Flinders University Adelaide South Australia Australia
Hacettepe University Ankara Turkey
Haydarpasa Numune Training and Research Hospital Istanbul Turkey
Hospital de Galdakao Usansolo Galdakao Spain
Hospital Germans Trias i Pujol Badalona Spain
Hospital Universitario Virgen Macarena Sevilla Spain
IRCCS Mondino Foundation Pavia Italy
Isfahan University of Medical Sciences Isfahan Iran
KTU Medical Faculty Farabi Hospital Trabzon Turkey
Liverpool Hospital Liverpool New South Wales Australia
Medical Faculty 19 Mayis University Samsun Turkey
Monash Medical Centre Melbourne Victoria Australia
Montreal Quebec Hopital Notre Dame Canada CHUM and Universite de Montreal Montreal Quebec Canada
Nemocnice Jihlava Jihlava Czech Republic
Neuro Rive Sud Quebec City Quebec Canada
Rehabilitation and MS Centre Overpelt and Hasselt University Hasselt Belgium
Royal Brisbane and Women's Hospital University of Queensland Brisbane Queensland Australia
UOC Neurologia Azienda Sanitaria Unica Regionale Marche AV3 Macerata Italy
References provided by Crossref.org
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- $a Kalincik, Tomas $u CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia tomas.kalincik@unimelb.edu.au. Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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- $a OBJECTIVE: Oral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed. METHODS: We identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring). RESULTS: The eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68). CONCLUSION: The effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.
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