Relapsing-remitting multiple sclerosis (RRMS) patients on Gilenya (fingolimod) have fewer relapses and stay on treatment longer than those taking Tecfidera (dimethyl fumarate) or Aubagio (teriflunomide), according to a new study.
The research, “Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis,” was published in the Journal of Neurology, Neurosurgery & Psychiatry.
Oral immunotherapies have been used as first-line treatment for patients with RRMS, but they have not been directly compared in randomized studies. Data from placebo-controlled clinical trials and observational groups suggested that Novartis’ Gilenya and Biogen’s Tecfidera have a similar ability to suppress inflammation, but Gilenya was the most effective option for patients who had switched from injectable therapies.
Comparing relapse and disability outcomes is needed for evidence-based choices of initial oral therapy, switching between oral medications, or treatment escalation due to prior failure, the researchers noted.
Aiming to address this gap, the team compared relapse activity, disability accumulation and lessening — quantified with one point increase or decrease, respectively, in the Expanded Disability Status Scale (EDSS) and confirmed over months — as well as treatment discontinuation among RRMS patients treated with Gilenya, Tecfidera or Sanofi Genzyme’s Aubagio.
Overall, the study included 614 patients on Aubagio (14 mg daily), 782 on Tecfidera (240 mg twice daily), and 2,332 on Gilenya (0.5 mg daily), treated between December 2006 and September 2017. Patients were identified in the global MSBase study, which is partially supported by Biogen, Novartis, and Sanofi Genzyme, and were followed for a median of 2.5 years.
All patients had been treated continuously with either therapy for a minimum of three months, and had not received treatment with Sanofi Genzyme’s Lemtrada (alemtuzumab) or stem cells. Also, they had a minimum of nine cerebral lesions, as assessed with magnetic resonance imaging (MRI).
A total of 109 (5.2%) patients on Aubagio, 275 (10.1%) on Tecfidera, and 221 (3.4%) on Gilenya discontinued therapy during the initial three months and were excluded from the analysis.
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