Abstract
BackgroundOral disease-modifying therapies offer equivalent or superior efficacy and greater convenience versus injectable options.ObjectivesTo compare patient-reported experiences of fingolimod and dimethyl fumarate.MethodsAdult relapsing-remitting multiple sclerosis patients treated with fingolimod or dimethyl fumarate were recruited from an online patient community and completed an online survey about treatment side effects, discontinuation, and satisfaction.Results281 patients in four groups completed the survey: currently receiving fingolimod (CF, N = 61), currently receiving dimethyl fumarate (CDMF, N = 129), discontinued fingolimod (DF, N = 32) and discontinued dimethyl fumarate (DDMF, N = 59). Reasons for treatment switch were to take oral treatment (CF: 63.3 %, CDMF: 61.8 %), side effects of prior medication (CF: 67.3 %, CDMF: 44.1 %) and lack of effectiveness of prior medication (CF: 38.8 %, CDMF: 31.4 %). Main reasons for discontinuation were side effects (DF: 46.9 %, DDMF: 67.8 %) and lack of effectiveness (DF: 25.0 %, DDMF: 15.3 %). CDMF patients had an increased risk of abdominal pain, flushing, diarrhea, and nausea. Treatment satisfaction was highest among CF patients followed by CDMF, DF, and then DDMF patients.ConclusionsDiscontinuation was driven by experience of side effects. Patients currently taking dimethyl fumarate were more likely to experience a side effect versus patients currently taking fingolimod. Examination of the relationship between tolerability and adherence/persistence is needed.
Highlights
Oral disease-modifying therapies offer equivalent or superior efficacy and greater convenience versus injectable options
The first section included questions about nine medication-specific side effects representing the top five side effects that could be perceived by patients for each of the two products based on incidence versus placebo as reported in the Food and Drug Administration (FDA) product labels for each product [7, 9]
Two patients were excluded from the analysis because their data indicated they had initiated current therapy less than 7 days prior to survey completion
Summary
Oral disease-modifying therapies offer equivalent or superior efficacy and greater convenience versus injectable options. Multiple sclerosis (MS) is a chronic inflammatory demyelinating condition of unknown etiology. It is one of the most common diseases of the central nervous system, affecting more than 2.3 million people worldwide [1]. From 1993 until recently, DMTs. Fingolimod (Gilenya®, Novartis Pharmaceuticals Corporation) [7], an oral DMT approved by the FDA in 2010, has shown to have superior efficacy to a comparator injectable DMT [8] and there is evidence of higher adherence and persistence, thought to be attributable in part to the improved tolerability profile as well as the mode of administration [2, 5]. Fingolimod is well-tolerated, it requires monitoring for 6 h after administering
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