Real-world Treatment Outcomes in People with Multiple Sclerosis Switched from Platform MS Treatments to Fumarates Versus Other Oral Disease-modifying Therapies
Jose Avila-Ornelas1, Khaled Abdalla2, Cortnee Roman3, Yujie Wang4, Marijean Buhse5, Boyang Bian6, James Lewin6, Nicholas Belviso6, Sai Shankar6
1Puerto Rico Multiple Sclerosis Center, 2Winchester Neurological Consultants, 3Rocky Mountain Multiple Sclerosis Clinic, 4Department of Neurology, University of Washington School of Medicine, 5NYU South Shore Neurologic Associates, 6Biogen
Objective:
Assess the real-world effectiveness of fumarates (FUM) compared to sphingosine 1-phosphate receptor modulators (S1Ps) and cladribine (CLAD) in people with multiple sclerosis (MS) switching from platform MS disease-modifying therapies (DMTs) by evaluating annualized relapse rates (ARR), healthcare resource utilization (HCRU), and healthcare costs (HCC).
Background:
MS is a chronic autoimmune disease causing significant morbidity and healthcare utilization. The varying benefit/risk profiles of DMTs complicate treatment choices. Real-world data on relapse rates and HCRU in patients switching from IFN, GA, or TERI to FUM versus S1P or CLAD are limited.
Design/Methods:
This retrospective study of the Komodo Health Claims Database included patients (18-64 years) with ≥1 claim for MS diagnosis. Patients were required to have a first claim for FUM, S1P, or CLAD ≤90 days after the last platform DMT claim between 01-Jan-2017 to 31-May-2022. Patients were followed until treatment discontinuation (>45-day gap), DMT switch, disenrollment, or death. ARR, time to first relapse, HCRU, and HCC were analyzed.
Results:
After 2:1 propensity score matching, 1090 FUM were compared to 545 S1P patients and 178 FUM to 89 CLAD patients. Mean age was 44–46 years, females comprising 74.5–77.5% between cohorts.
The mean [95% CI] population-level ARR in FUM vs. S1P were 0.06 [0.05–0.08] vs 0.06 [0.04–0.08] (p=0.63) and in FUM vs. CLAD were 0.04 [0.02–0.08] vs 0.07 [0.02–0.22] (p=0.367), respectively. At 24 months, relapse-free rates proportion [95% CI] were 90.3% [87.6–93.1] FUM vs 91.4% [88.5–94.4] S1P (p=0.94) and 95.3% [91.5–99.2] FUM vs 93.1% [87.0–99.6] CLAD (p=0.61). No significant differences in HCRU (all-cause or MS-related) were observed. MS-related HCC [95% CI] were $640.16 [603.77–678.74] FUM vs. S1P $720.06 [653.47–793.43] (p=0.044). FUM and CLAD HCCs were similar.
Conclusions:
In MS patients switching from platform therapies, FUM provides similar effectiveness and HCRU compared to S1Ps and CLAD.
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