Dimethyl fumarate vs Teriflunomide: an Italian time-to-event data analysis

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Oral disease-modifying therapies (DMTs) have transformed the treatment landscape for relapsing-remitting multiple sclerosis (RRMS).
• Understanding the comparative effectiveness of different oral DMTs is crucial for optimizing patient care.

Purpose of the Study:

• To compare the real-world effectiveness of dimethyl fumarate (DMF) and teriflunomide (TRF) in a large, multicenter Italian cohort of RRMS patients.
• To evaluate treatment outcomes based on time-to-first-relapse, time-to-Magnetic Resonance Imaging (MRI)-activity, and time-to-disability-progression.

Main Methods:

• A retrospective analysis of 1445 RRMS patients treated with DMF or TRF between 2012 and 2018 across twelve Italian multiple sclerosis centers.
• Time-varying Cox-model analysis was employed to assess the primary outcomes, adjusting for baseline characteristics.

Main Results:

• Patients on TRF were older, predominantly male, and had a higher baseline disability level compared to those on DMF.
• While no significant difference in relapse risk was observed within the first 38 months, DMF demonstrated a significantly lower hazard of relapse beyond 38 months of therapy (HR=3.83, p=0.033).
• Both DMF and TRF showed comparable efficacy in controlling MRI activity and preventing disability progression.

Conclusions:

• Dimethyl fumarate (DMF) offers superior relapse-free survival compared to teriflunomide (TRF) for relapsing-remitting multiple sclerosis patients after 38 months of treatment.
• Both oral DMTs effectively manage disease activity and disability progression, but DMF may provide additional benefits in long-term relapse prevention.