Related Experiment Video
Updated: Jul 11, 2025
A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
Discontinuation of dimethyl fumarate in multiple sclerosis - a nationwide study
Malte Roar1, Amalie Rhode Høgh Nielsen2, Jonas Munksgaard Berg3
1Department of Neurology, Aalborg University Hospital, Denmark.
Background:
Adherence is a prerequisite for the efficacy of any drug, and previous studies have shown that non-adherence is associated with disease activity and increased health care cost in multiple sclerosis (MS). The aim of this study was to investigate rates and reasons for discontinuation of dimethyl fumarate (DMF) among people with MS on a national level and differences between clinics in Denmark.
Methods:
This was a nationwide, registry and population study of patients treated with DMF. We calculated standard residuals (SR) demonstrate differences between clinics. For survival analysis regarding discontinuation rates and discontinuation due to specific AEs we used log-rank test Cox-proportional hazards and plotted Kaplan-Meier graphics.
Results:
We included 2,448 people with MS, treated with DMF from 2013 to 2020. Average treatment duration was 26 months (5,382 treatment years). 49.2 % of patients who initiated treatment with DMF (n = 1205) were continuously treated. Reasons for discontinuation were adverse events (54.5 %, n = 656), active disease (26.1 %, n = 315), pregnancy (9.4 %, n = 113) or other reasons (13.2 %, n = 159). We compared SR to the mean regarding reasons for discontinuation and found significant differences between sites regarding gastrointestinal adverse events, flushing and lymphopenia. Discontinuation due to all adverse events, flushing and lymphopenia were more frequent in female than male patients.
Conclusion:
In this population-based study, we found major differences between the MS clinics in rates and reason for discontinuation of DMF. Our results suggest that management strategies during DMF treatment can reduce discontinuation rates.
Insights
Nearly half of multiple sclerosis patients discontinued dimethyl fumarate (DMF), with adverse events being the primary reason. Clinic management strategies may reduce DMF discontinuation rates.
Area of Science:
- Neurology
- Pharmacology
- Public Health
Background:
- Adherence to disease-modifying therapies is crucial for managing multiple sclerosis (MS).
- Non-adherence in MS is linked to increased disease activity and healthcare costs.
- Dimethyl fumarate (DMF) is a common treatment for MS, but discontinuation rates and reasons are not fully understood on a national level.
Purpose of the Study:
- To investigate the rates and reasons for discontinuation of dimethyl fumarate (DMF) in a nationwide cohort of patients with multiple sclerosis (MS) in Denmark.
- To identify differences in DMF discontinuation rates and reasons between various MS clinics.
- To explore factors influencing treatment adherence and persistence with DMF therapy.
Main Methods:
- A nationwide registry and population-based study design was employed.
- Data from 2,448 patients with MS treated with DMF between 2013 and 2020 were analyzed.
- Survival analysis, including log-rank tests and Cox-proportional hazards models, was used to assess discontinuation rates and reasons.
Main Results:
- Of 2,448 patients, 49.2% remained on DMF treatment continuously, with an average treatment duration of 26 months.
- Adverse events were the most common reason for discontinuation (54.5%), followed by active disease (26.1%).
- Significant inter-clinic variations were observed in discontinuation rates due to gastrointestinal adverse events, flushing, and lymphopenia, with females experiencing higher rates of discontinuation due to adverse events.
Conclusions:
- Substantial differences exist between MS clinics regarding DMF discontinuation rates and reasons.
- Adverse events, particularly gastrointestinal issues, flushing, and lymphopenia, are major drivers of DMF discontinuation.
- Implementing targeted management strategies within MS clinics has the potential to improve patient adherence and reduce DMF discontinuation.
