Effectiveness of teriflunomide in patients with relapsing multiple sclerosis who switched from other...

To examine effectiveness of teriflunomide in patients with multiple sclerosis (MS) who switched to teriflunomide from other disease-modifying therapies (DMTs). Retrospective, observational, pre-post analysis of adults with relapsing MS (RMS; relapsing-remitting MS or active secondary progressive MS [aSPMS]) with prescription for teriflunomide between September 1, 2012, and March 31, 2019, and had been treated with another disease-modifying therapy ("switched"). Data were extracted from medical-chart data from a single US neurology center in California. Index was the date of teriflunomide initiation. Data were extracted at 1-year pre-index, index, and 1- and 2-years post-index. Patients were observed until death, loss to follow-up, or study end. A subgroup of patients with aSPMS were also examined. For inferential comparisons, significance was assessed using paired T-test or Wilcoxon rank sum test, as appropriate. P < .05 was considered significant. Eighty patients with RMS formed the main analysis. At index, mean (±SD) age was 44.0 ± 14.6 years, 71.3% were female, mean duration of MS was 9.3 ± 6.4 years. Mean duration of teriflunomide use was 24.9 ± 14.2 months. Magnetic resonance imaging of lesions were "stable" or "improved" in most patients at baseline (92.5%), at 1-year (95.1%) or 2-years (97.6%). Mean annualized relapse rate decreased by 80.8%, from 0.26 at 1-year pre-teriflunomide initiation to 0.05 at 2-years post-index (P < .001). Mean Expanded Disability Status Scale (EDSS) score slightly increased from 1-year pre-index to 1-year post-index (3.84 vs 3.90, respectively; difference: -0.06 [P = .033]) but was nonsignificant from index to 2-years post-index (3.84 vs 3.94; difference: -0.06 [P = .058]). Montreal Cognitive Assessment and timed 25-foot walk test scores remained stable through follow-up. A decrease in proportion of patients with lymphopenia was recorded from index (30.0%) to 2-years post-index (1.3%). In the subset of patients with aSPMS (n = 32), mean annualized relapse rate reduced from 1-year pre-index to 2-years post-index (0.4 vs 0.03; change: -0.38 [P < .001]). EDSS, Montreal Cognitive Assessment, and timed 25-foot walk test scores remained stable in patients with aSPMS. After switching to teriflunomide, patients with RMS (relapsing-remitting MS or aSPMS) experienced a reduction in relapses and evidence for recovery from lymphopenia. Other markers of disability worsening, including EDSS, remained stable after switching to teriflunomide.