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Time-dependent divergence in infection risks among patients with multiple sclerosis treated with fumarates versus
Kyle Smoot1, Erin E Longbrake2, Mirla Avila3
1Providence Neurological Specialties, Portland, OR, USA.
Background:
People with multiple sclerosis (pwMS) treated with anti-CD20 monoclonal antibodies have an elevated infection risk, yet long-term comparative data with oral fumarates are limited.
Objective:
To compare infection incidence, healthcare resource utilization, and relapse outcomes among pwMS receiving fumarate or anti-CD20 therapy for ⩾2 years.
Methods:
This retrospective propensity-matched (1:2) analysis used US Komodo Health claims (1 January 2016-31 May 2022) for pwMS aged 18-64 years with ⩾2 years of continuous follow-up. Outcomes were assessed using Poisson generalized linear models.
Results:
A total of 1956 pwMS were matched (fumarates: n = 652; anti-CD20s: n = 1304), with mean follow-up ~3 years. By year 2, the fumarates group had a lower infection rate than anti-CD20s (rate ratio: 0.84; 95% CI: 0.73-0.97; p = 0.016), but the most substantial difference was observed in years 4+, where fumarate-treated patients had a 30% reduction versus anti-CD20s (rate ratio: 0.70; 95% CI: 0.52-0.95; p = 0.021).
Conclusions:
Fumarate therapy was associated with a lower infection risk versus anti-CD20s. The infection rate in the fumarates group remained relatively stable over time, but it progressively increased in the anti-CD20 group, with the most prominent differences observed at year 4 and beyond.
Insights
People with multiple sclerosis treated with fumarates experienced lower infection rates compared to those on anti-CD20 therapies. This safety benefit of fumarates persisted and widened over four years of treatment.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- People with multiple sclerosis (pwMS) on anti-CD20 monoclonal antibodies face increased infection risks.
- Limited long-term comparative data exists for oral fumarates versus anti-CD20 therapies regarding infection risk.
Purpose of the Study:
- To compare infection incidence between pwMS treated with fumarates and those treated with anti-CD20 therapies.
- To evaluate healthcare resource utilization and relapse outcomes in these patient groups over a minimum of two years.
Main Methods:
- Retrospective propensity-matched analysis of US Komodo Health claims data from January 2016 to May 2022.
- Included pwMS aged 18-64 years with at least two years of continuous follow-up.
- Used Poisson generalized linear models to assess outcomes.
Main Results:
- 1956 pwMS were matched (652 fumarates, 1304 anti-CD20s) with a mean follow-up of approximately three years.
- By year two, fumarate therapy showed a lower infection rate (RR: 0.84; p=0.016).
- By year four and beyond, fumarate-treated patients had a 30% reduction in infection risk compared to anti-CD20s (RR: 0.70; p=0.021).
Conclusions:
- Fumarate therapy is associated with a significantly lower risk of infection compared to anti-CD20 therapies in pwMS.
- Infection rates remained stable over time with fumarates but progressively increased with anti-CD20s, particularly after four years.
