Switching from CD20 inhibitors to fumarates may be OK in stable MS
De-escalating to less effective therapy may mitigate safety concerns
Switching from anti-CD20 medications to less effective fumarate therapies is linked to reduced healthcare visits and costs related to infections after a year, without affecting the rate of relapses in stable multiple sclerosis (MS).
That’s according to an analysis of a U.S. healthcare claims database, which compared switchers against people who stayed on CD20 inhibitors. The findings suggest de-escalating from a highly effective therapy to a moderately effective one may mitigate some safety concerns for people whose disease is stable.
The study, “Clinical characteristics and treatment outcomes in multiple sclerosis patients treated with anti-CD20s who switched to fumarates: a retrospective analysis of a US healthcare claims database,” was published in the Journal of Comparative Effectiveness Research.
It’s generally recommended that MS patients start a high-efficacy disease-modifying therapy (DMT) as soon as possible after a diagnosis, doing so being associated with better outcomes in the long run.
But these medications come with a higher risk of safety issues, which may prompt treatment switches to mitigate the risk of infections and other side effects. This sometimes involves switching to a less effective therapy with a more manageable safety profile.
In the U.S., the most commonly used highly effective therapies are CD20 inhibitors such as Ocrevus (ocrelizumab), Kesimpta (ofatumumab), Briumvi (ublituximab), and rituximab (sold as Rituxan and others). Moderately effective treatments include fumarate therapies such as Tecfidera (dimethyl fumarate) and Vumerity (diroximel fumarate).
Should you stay or should you go now?
Data on those who switched from anti-CD20 therapies to other medications are limited, leading scientists at Biogen, which markets Tecfidera and Vumerity, to explore the outcomes among those who switched medications.
The researchers retrospectively analyzed claims data from 2017 to 2022 and identified 108 patients with stable disease, defined as no relapses in the last year of treatment, while on CD20 inhibitors who switched to fumarate therapies. Each patient was matched to five patients in the database who stayed on anti-CD20 therapy.
Switchers and stayers had similar relapse rates after a mean follow-up of 341 days (about 11 months), the results showed. After a year, 89% of switchers remained relapse-free compared with 91.9% of stayers.
While the differences weren’t statistically significant, a higher proportion of patients who switched treatment had a relapse (10.2% vs. 6.7%) and also took less time before experiencing a first relapse (190 vs. 251 days).
The number healthcare visits and healthcare costs per year were similar for both groups overall. Visits related to an infection were also similar.
However, the annual rate of infections that required an inpatient stay was significantly lower in those who switched from anti-CD20 antibodies compared with stayers (0.01 vs. 0.06). Overall infection-related healthcare costs were also significantly reduced (about $543 vs. $2,954), as were the costs associated with infection-related inpatient care ($70 vs. $2,396).
“This study provides evidence that switching from anti-CD20 [monoclonal antibodies] to fumarates, in patients who have been clinically stable, can provide benefits associated with fewer infection-related inpatient [healthcare visits] and lower infection-related [healthcare costs], while maintaining effectiveness in terms of relapse rate,” the researchers wrote.
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