Contributions
Abstract: EP1481
Type: ePoster
Abstract Category: Therapy - disease modifying - Immunomodulation/Immunosuppression
Background: Recently approved disease-modifying therapies (DMTs) have changed the disease management of multiple sclerosis (MS). However, the comparative effectiveness between different DMTs has not been comprehensively studied in a real-world setting.
Objectives: To compare the change in annual relapse rate (ARR) in MS patients initiating dimethyl fumarate (DMF), glatiramer acetate (GA), interferons (IFN), fingolimod (FTY), or teriflunomide (TER).
Methods: The study used data from January 1, 2012- March 31, 2015 of MarketScan, a large US commercial insurance database. Adult MS patients (18-64 years) who initiated a DMT of interest in January 1, 2013-March 31, 2014 were included. The main outcome of interest, ARR, was calculated in the year before vs. in the year after the DMT initiation. The reduction in ARR over time was compared across DMT cohorts. Poisson regression with difference-in-difference estimate was used to compare the reduction in ARR over time across DMT groups (use DMF as the reference) while adjusting for the difference in demographics, comorbidities, and DMT use in the baseline year.
Results: A total of 3,822 DMF, 1,207 GA, 1,008 IFN, 669 FTY, and 537 TER patients were included in the analysis. Differences were seen in age (46.8, 43.7, 44.0, 43.8, and 49.5, respectively; p< 0.01), proportion of females (76.5%, 78.0%, 77.5%, 75.0% vs. 79.1%, respectively; p=0.37), proportion with other DMT in the prior year (67.5%, 14.5%, 12.4%, 62.5% and 63.9%, respectively; p< 0.01), ARR in the prior year (0.42, 0.32, 0.37, 0.44, and 0.39, respectively; p< 0.01), and ARR in the year post DMT initiation (0.30, 0.34, 0.34, 0.30, 0.35, respectively; p< 0.01). After initiation, ARR reduced significantly in the DMF (-0.12, p< 0.01) and FTY (-0.14, p< 0.01) but not in GA (+0.02, p=0.32), IFN (-0.03, p=0.21), and TER (-0.04, p=0.23) groups. After adjusting for confounders, DMF group had significantly higher reduction in ARR than GA (p< 0.01), IFN (p< 0.01), and TER (p=0.03) groups but was not different from the FTY group (p=0.69).
Conclusions: After initiation, DMF was associated with significantly more reduction in ARR than GA, IFN, and TER in this analysis of real-world data. No significant difference was observed between DMF and FTY.
Disclosure:
AB: has received research funding from Genentech, Actellion and Mallenkropt, and has received consulting and speaking honoraria from Genzyme, Novartis, Teva, Biogen and Medtronic.
JN: has received research funding from Genzyme, Novartis, Teva, Biogen and Alexion, and has received consulting and speaking honoraria from Genzyme, Novartis, Teva, Biogen and Medtronic.
NW, WSY, MF, ME, MYH, AL: Employees of and hold stock/stock options in Biogen.
Abstract: EP1481
Type: ePoster
Abstract Category: Therapy - disease modifying - Immunomodulation/Immunosuppression
Background: Recently approved disease-modifying therapies (DMTs) have changed the disease management of multiple sclerosis (MS). However, the comparative effectiveness between different DMTs has not been comprehensively studied in a real-world setting.
Objectives: To compare the change in annual relapse rate (ARR) in MS patients initiating dimethyl fumarate (DMF), glatiramer acetate (GA), interferons (IFN), fingolimod (FTY), or teriflunomide (TER).
Methods: The study used data from January 1, 2012- March 31, 2015 of MarketScan, a large US commercial insurance database. Adult MS patients (18-64 years) who initiated a DMT of interest in January 1, 2013-March 31, 2014 were included. The main outcome of interest, ARR, was calculated in the year before vs. in the year after the DMT initiation. The reduction in ARR over time was compared across DMT cohorts. Poisson regression with difference-in-difference estimate was used to compare the reduction in ARR over time across DMT groups (use DMF as the reference) while adjusting for the difference in demographics, comorbidities, and DMT use in the baseline year.
Results: A total of 3,822 DMF, 1,207 GA, 1,008 IFN, 669 FTY, and 537 TER patients were included in the analysis. Differences were seen in age (46.8, 43.7, 44.0, 43.8, and 49.5, respectively; p< 0.01), proportion of females (76.5%, 78.0%, 77.5%, 75.0% vs. 79.1%, respectively; p=0.37), proportion with other DMT in the prior year (67.5%, 14.5%, 12.4%, 62.5% and 63.9%, respectively; p< 0.01), ARR in the prior year (0.42, 0.32, 0.37, 0.44, and 0.39, respectively; p< 0.01), and ARR in the year post DMT initiation (0.30, 0.34, 0.34, 0.30, 0.35, respectively; p< 0.01). After initiation, ARR reduced significantly in the DMF (-0.12, p< 0.01) and FTY (-0.14, p< 0.01) but not in GA (+0.02, p=0.32), IFN (-0.03, p=0.21), and TER (-0.04, p=0.23) groups. After adjusting for confounders, DMF group had significantly higher reduction in ARR than GA (p< 0.01), IFN (p< 0.01), and TER (p=0.03) groups but was not different from the FTY group (p=0.69).
Conclusions: After initiation, DMF was associated with significantly more reduction in ARR than GA, IFN, and TER in this analysis of real-world data. No significant difference was observed between DMF and FTY.
Disclosure:
AB: has received research funding from Genentech, Actellion and Mallenkropt, and has received consulting and speaking honoraria from Genzyme, Novartis, Teva, Biogen and Medtronic.
JN: has received research funding from Genzyme, Novartis, Teva, Biogen and Alexion, and has received consulting and speaking honoraria from Genzyme, Novartis, Teva, Biogen and Medtronic.
NW, WSY, MF, ME, MYH, AL: Employees of and hold stock/stock options in Biogen.