Comparative Effectiveness of Dimethyl Fumarate Versus Fingolimod and Teriflunomide on the Risk of Relapse in MS Patients Switching from First-Generation Platform Therapies in the US (P1.374)

Objective: To compare the time to first relapse (TTFR) in multiple sclerosis (MS) patients who have switched from a platform therapy (interferons or glatiramer acetate) to an oral therapy: dimethyl fumarate (DMF), fingolimod (FTY), or teriflunomide (TERI) Background: Suboptimal responses in patients with MS receiving 1 st -generation platform therapies may prompt treatment changes. However, limited comparative evidence is available in patients switching from a platform to an oral disease modifying therapy (DMT). Design/Methods: MS patients (18–64 years old) initiating an oral DMT from June 2013–March 2015 were identified from the MarketScan® Commercial Claims Database. The index date was the date of first oral DMT fill. Inclusion criteria were: continuous enrollment in dataset for 12 months pre-index date and ≥3 months post-index date; discontinuation of a platform DMT with no oral/infusion DMT over the pre-index period; and adherence to the index drug for ≥90 days. DMF patients were propensity-score matched (PSM) 3:1 to FTY and TERI based on demographical and clinical characteristics. TTFR over the follow-up period was recorded. Results: The database included 20,311 oral DMT-users. After applying the study criteria, the PSM yielded 833:279 patients for the DMF-TERI match and 1602:534 patients for the DMF-FTY match. The standardized differences confirmed balance across all covariates for matched cohorts (DMF-TERI: age, 50 years for both; gender, 76% vs. 75% female; MS severity score, 0.86 vs. 0.99; baseline ARR, 0.23 vs. 0.30 |DMF-FTY: age, 44 for both; gender, 72% vs. 74% female; MS severity score, 0.99 vs. 1.1; baseline ARR, 0.40 vs. 0.44). TERI was associated with a 47% (HR: 1.47; p=0.01) increased risk of relapse relative to DMF; no significant difference was observed between FTY and DMF (HR: 1.004; p=0.97). Conclusions: Consistent with previous findings, DMF shows greater efficacy than TERI and similar efficacy as compared to FTY in patients switching from platform therapies. Study Supported by: Biogen Disclosure: Dr. Nicholas has nothing to disclose. Dr. Carraro has nothing to disclose. Dr. Ontaneda has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Merck, Biogen Idec, Genzyme. Research support from Novartis, Genentech and Genzyme. Dr. Zhou has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen. Dr. Hou has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen. Dr. Babb has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with MCPHS. Dr. Babb has received research support from Biogen. Dr. Riester has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with employee of Biogen. Dr. Riester holds stock and/or stock options in holds stock/stock options in Biogen. Dr. Mendoza has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen. Dr. Livingston has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen. Dr. Jhaveri has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen. Dr. Jhaveri holds stock and/or stock options in Biogen. Dr. Jhaveri has received research support from Biogen.