Abstract
BackgroundDimethyl fumarate and fingolimod are oral disease modifying treatments (DMTs) that reduce relapse activity and slow disability worsening in relapsing–remitting multiple sclerosis (RRMS).ObjectiveTo compare the effectiveness of dimethyl fumarate and fingolimod in a real-world setting, where both agents are licensed as a first-line DMT for the treatment of RRMS.MethodsWe identified patients with RRMS commencing dimethyl fumarate or fingolimod in the Swiss Federation for Common Tasks of Health Insurances (SVK) Registry between August 2014 and July 2019. Propensity score-matching was applied to select subpopulations with comparable baseline characteristics. Relapses and disability outcomes were compared in paired, pairwise-censored analyses.ResultsOf the 2113 included patients, 1922 were matched (dimethyl fumarate, n = 961; fingolimod, n = 961). Relapse rates did not differ between the groups (incident rate ratio 1.0, 95%CI 0.8–1.2, p = 0.86). Moreover, no difference in the hazard of 1-year confirmed disability worsening (hazard ratio [HR] 0.9; 95%CI 0.6–1.6; p = 0.80) or disability improvement (HR 0.9; 95%CI 0.6–1.2; p = 0.40) was detected. These findings were consistent both for treatment-naïve patients and patients switching from another DMT.ConclusionDimethyl fumarate and fingolimod have comparable effectiveness regarding reduction of relapses and disability worsening in RRMS.
Highlights
Dimethyl fumarate and fingolimod are oral drugs, which are approved as first-line disease modifying treatment (DMT) for patients with relapsing–remitting multiple sclerosis (RRMS) in Switzerland [1, 2]
We identified 2113 eligible patients treated with dimethyl fumarate or fingolimod
The logistic model used to estimate the propensity scores showed that fewer relapses in the year before treatment start, a higher number of previous DMTs as well as being treated in the Eastern region of Switzerland were associated with a higher probability of treatment with dimethyl fumarate (Supplementary Table 2)
Summary
Dimethyl fumarate and fingolimod are oral drugs, which are approved as first-line disease modifying treatment (DMT) for patients with relapsing–remitting multiple sclerosis (RRMS) in Switzerland [1, 2]. Both agents effectively reduce relapse activity and delay short-term disability worsening in patients with RRMS compared to placebo [3,4,5,6,7]. A matching-adjusted study of pooled data from four phase III trials found comparable effects on relapses and disability outcomes of the two compounds [8].
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