Comparative Effectiveness of Fumarates Versus Sphingosine-1-Phosphate Receptor Modulators in Black Patients with...

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Multiple sclerosis (MS) disproportionately affects Black individuals, who experience more severe disease and higher relapse rates.
• Fumarates and sphingosine-1-phosphate (S1P) receptor modulators are common oral disease-modifying therapies (DMTs) for relapsing MS.
• Comparative effectiveness of these DMTs in Black patients with MS (PwMS) remains understudied.

Purpose of the Study:

• To compare the effectiveness of fumarates versus S1P receptor modulators in Black PwMS using real-world data.
• To evaluate treatment outcomes, specifically annualized relapse rate (ARR) and time to first relapse.

Main Methods:

• Retrospective analysis of claims data from the Komodo Health Claims Database (January 2017-April 2023).
• Included Black PwMS aged 18-64 with MS diagnosis and prescription claims for fumarates or S1P receptor modulators.
• Propensity score matching (2:1) and inverse probability weighting were employed to balance baseline characteristics.

Main Results:

• The study included 1664 Black PwMS (1231 on fumarates, 433 on S1P modulators).
• Post-index annualized relapse rates were comparable between the fumarate and S1P groups (Rate Ratio = 1.18, p=0.423).
• Kaplan-Meier analysis showed similar relapse-free proportions at 24 months (72.6% for fumarates, 74.7% for S1P modulators; p=0.152).

Conclusions:

• Fumarates and S1P receptor modulators demonstrate similar effectiveness in reducing relapses among Black PwMS in a real-world setting.
• Over 72% of patients in both groups remained relapse-free at 24 months.
• These findings provide valuable real-world evidence to inform treatment decisions for Black PwMS, addressing a gap due to underrepresentation in clinical trials.