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Updated: Jun 25, 2025
A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
Comparative effectiveness of dimethyl fumarate versus non-specific immunosuppressants: Real-world evidence from
Tim Spelman1,2, Sara Eichau3, Raed Alroughani4
1MSBase Foundation, Melbourne, Australia.
Background:
The use of non-specific immunosuppressants (NSIS) to treat multiple sclerosis (MS) remains prevalent in certain geographies despite safety concerns, likely due to resource limitations.
Objective:
To use MSBase registry data to compare real-world outcomes in adults with relapsing-remitting MS (RRMS) treated with dimethyl fumarate (DMF) or NSIS (azathioprine, cyclosporine, cyclophosphamide, methotrexate, mitoxantrone or mycophenolate mofetil) between January 1, 2014 and April 1, 2022.
Methods:
Treatment outcomes were compared using inverse probability of treatment weighting (IPTW) Cox regression. Outcomes were annualized relapse rates (ARRs), time to discontinuation, time to first relapse (TTFR) and time to 24-week confirmed disability progression (CDP) or 24-week confirmed disability improvement (CDI; in patients with baseline Expanded Disability Status Scale [EDSS] score ≥2).
Results:
After IPTW, ARR was similar for DMF (0.13) and NSIS (0.16; p = 0.29). There was no difference in TTFR between cohorts (hazard ratio [HR]: 0.98; p = 0.84). The DMF cohort experienced longer times to discontinuation (HR: 0.75; p = 0.001) and CDP (HR: 0.53; p = 0.001), and shorter time to CDI (HR: 1.99; p < 0.008), versus the NSIS cohort.
Conclusion:
This analysis supports the use of DMF to treat patients with relapsing forms of MS, and may have implications for MS practices in countries where NSIS are commonly used to treat RRMS.
Insights
Dimethyl fumarate (DMF) shows comparable relapse rates but better outcomes in discontinuation, disability progression, and improvement compared to non-specific immunosuppressants (NSIS) for multiple sclerosis (MS). This supports DMF use in relapsing MS.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Non-specific immunosuppressants (NSIS) are still widely used for multiple sclerosis (MS) globally, despite safety concerns.
- Resource limitations may contribute to the continued use of NSIS in certain regions.
Purpose of the Study:
- To compare real-world outcomes of dimethyl fumarate (DMF) versus NSIS in adults with relapsing-remitting MS (RRMS).
- To evaluate efficacy and safety endpoints including relapse rates, discontinuation, and disability progression/improvement.
Main Methods:
- Utilized MSBase registry data from January 1, 2014, to April 1, 2022.
- Employed inverse probability of treatment weighting (IPTW) Cox regression for outcome comparison.
- Assessed annualized relapse rates (ARRs), time to discontinuation, time to first relapse (TTFR), and time to confirmed disability progression (CDP) or improvement (CDI).
Main Results:
- ARRs were similar between DMF (0.13) and NSIS (0.16) groups (p=0.29).
- No significant difference in TTFR was observed (HR: 0.98; p=0.84).
- DMF showed significantly longer time to discontinuation (HR: 0.75; p=0.001) and CDP (HR: 0.53; p=0.001), and shorter time to CDI (HR: 1.99; p<0.008) compared to NSIS.
Conclusions:
- Dimethyl fumarate (DMF) is a viable treatment option for relapsing forms of MS, demonstrating improved outcomes in key areas compared to NSIS.
- Findings may influence MS treatment guidelines in regions where NSIS remain a common choice for RRMS management.
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