First-line moderate-efficacy DMTs show similar efficacy

A Spanish retrospective observational study compared the effectiveness and persistence of first-line, moderately effective disease-modifying treatments (DMTs): injectable drugs, dimethyl fumarate, and teriflunomide. No difference in effectiveness was observed. However, injectable drugs were associated with a higher discontinuation rate and lower persistence.

No head-to-head trials have been conducted comparing injectable drugs, dimethyl fumarate, and teriflunomide, all approved for the first-line treatment of MS. Thus, Dr Clara López-Caneda (Hospital Alvaro Cunqueiro, Spain) and colleagues conducted a retrospective observational study to evaluate the relative effectiveness and persistence of these drugs in a real-world setting [1].

Between early 2015 and early 2024, the researchers included 400 patients who started a first-line MS treatment (132 patients with MS were prescribed injectable drugs, 130 dimethyl fumarate, and 138 teriflunomide). Clinical and radiological variables were compared. Efficacy was evaluated in terms of percentages of patients reaching NEDA-2 (i.e. absence of relapses and progression of disability) and NEDA-3 (i.e. NEDA-2 plus absence of new T2 lesions or Gd-enhancing lesions on brain MRI). Dropout was defined as DMT discontinuation for any reason for at least 6 months.

During the first year of treatment, 79.8% of the participants had NEDA-2 and 59.9% NEDA-3. Teriflunomide was associated with the most favourable outcome, with 87.0% of users reaching NEDA-2, compared with 77.6% on injectable drugs and 73.8% on dimethyl fumarate (P<0.05). The survival analysis yielded no differences between the treatments in reaching NEDA-2 (P=0.27) and NEDA-3 (P=0.95). Participants using injectable drugs had a higher dropout rate (62.12%) compared with dimethyl fumarate (43.08%) and teriflunomide (40.58%) (P<0.001). Treatment persistence was higher with dimethyl fumarate and lower with injectable drugs (P=0.01).

1. López-Caneda C, et al. Persistence and effectiveness of moderate efficacy drugs in multiple sclerosis patients. Real world data. P382, ECTRIMS 2024, 18–20 September, Copenhagen, Denmark.

 

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Posted on 18 November 202418 November 2024