Real-world Treatment Outcomes in Black, Hispanic, Asian, and White People with Multiple Sclerosis Treated with Fumarates
Sophia Woodson1, Edward Gettings2, Chu-Yueh Guo3, Sylvia Klineova4, Jong-Mi Lee5, Rebecca Romero6, Aljoeson Walker7, Kinyee Fong8, Jason Mendoza8, Nicholas Belviso8, Boyang Bian8, James Lewin8, Sai Shankar8
1University Hospitals, 2Temple Health, 3University of California San Francisco Health, 4Mount Sinai, 5Stanford Medicine, 6University of Texas Health, 7Medical University of South Carolina, 8Biogen
Objective:
To assess the effectiveness of fumarates (FUM) in Black, Hispanic, Asian, and White people with multiple sclerosis (pwMS).
Background:
Racial/ethnic minority patient populations are generally underrepresented in clinical trials. Dimethyl fumarate (DMF) and diroximel fumarate (DRF) are disease-modifying therapies for relapsing MS. Data describing FUM effectiveness in racial/ethnic pwMS are limited.
Design/Methods:
This retrospective analysis of the Komodo Health Claims Database included patients 18-64 years old with ≥1 claim for MS diagnosis and a claim for DMF or DRF between 01-Jan-2017 to 31-May-2022. Index date was the first FUM claim date. Patients were followed from index to first occurrence of end of study, end of insurance eligibility, gap >45 days, or DMT switch.
Results:
This analysis included 1241 Black, 777 Hispanic, 132 Asian, and 4650 White pwMS treated with FUM. Baseline mean (SD) MS severity scores were: Black, 7.1 (4.2); Hispanic, 6.4 (4.0); Asian, 6.0 (3.3); and White, 6.4 (4.1). Baseline (1 year pre-index) annualized relapse rate (ARR) (95% CI) was 0.338 (0.297-0.385) in Black patients, compared with 0.311 (0.258-0.376), 0.295 (0.212-0.412), and 0.299 (0.273-0.326) in Hispanic, Asian, and White patients, respectively. Mean FUM exposure post-index ranged from 449-559 days. Post-index, ARR (95% CI) reduced to 0.252 (0.212-0.300) in Black patients, compared with 0.185 (0.138-0.248), 0.163 (0.104-0.256), and 0.214 (0.182-0.251) in Hispanic, Asian, and White patients, respectively. Estimated proportions relapse-free (95% CI) at 24 months were: Black, 77.0% (73.7%-80.3%); Hispanic, 75.4% (71.0%-80.0%), Asian, 81.7% (73.0%-90.3%); and White, 80.5% (70.0%-82.1%). Absolute lymphocyte count reductions (95% CI) after 12 months on FUM were 10.3% (3.8%-16.3%), 20.1% (14.8%-25.1%), 14.4% (0.6%-26.3%) and 20.4% (18.0%-22.7%) in Black, Hispanic, Asian, and White patients, respectively.
Conclusions:
Similar FUM efficacy was observed in all racial/ethnic subgroups in this analysis of 2150 racial/ethnic minority pwMS, consistent with prior studies.