Fingolimod Significantly Reduces Relapse in MS Compared With Dimethyl Fumarate, Teriflunomide

A recent study sought to compare several available oral immunotherapies for the treatment of relapsing-remitting multiple sclerosis (RRMS).

Researchers identified patients through the MsBase, an international observational multiple sclerosis (MS) cohort study, and enrolled patients with RRMS who had been treated with teriflunomide (Aubagio; n = 614), dimethyl fumarate (Tecfidera; n = 782), or fingolimod (Gilenya; n = 2332) for a minimum of 3 months.

While each of these therapies are effective at controlling MS activity, the study authors noted that prior studies failed to evaluate and compare their efficacy on relapse and disability.

The study compared dimethyl fumarate versus teriflunomide, fingolimod versus dimethyl fumarate, and fingolimod versus teriflunomide to investigate the therapy’s impact on relapse activity, 6-month disability worsening or improvement, and persistence of treatment. Patients were followed for a median of 2.5 years.

Relapse was defined as the occurrence of new symptoms or exacerbation of existing ones for a period of over 24 hours, at least 30 days after a previous relapse. Disability was assessed according to the Expanded Disability Status Scale.

The researchers found that patients treated with fingolimod had significantly lower annualized relapse rates than those taking dimethyl fumarate (0.20 vs 0.26; P = .01) or teriflunomide (0.18 vs 0.24; P = .05). However, patients taking dimethyl fumarate and teriflunomide had a similar rate (0.19 vs 0.22; P = .55). Interestingly, during the 2.5-year period studied, the study authors found no differences in disability accumulation (P ≥.59) or improvement (P ≥.14) among the 3 therapies.

Overall, the results showed that fingolimod treatment may have a greater impact on relapse frequency in patients with RRMS compared with dimethyl fumarate and teriflunomide. Although “the effect of the 3 oral therapies on disability outcomes was similar during the initial 2.5 years on treatment… persistence on fingolimod was superior to the 2 comparator drugs,” wrote the authors.

Reference

Kalincik T, Havrdova E, Horakova D, et al. Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis [published online January 13, 2019]. J Neurol Neurosurg Psychiatry. doi: 10.1136/jnnp-2018-319831.