Contributions
Abstract: P375
Type: Poster
Abstract Category: Clinical aspects of MS - Economic burden
Background: Fingolimod (FTY) and dimethyl fumarate (DMF) are two commonly used oral disease modifying therapies (DMTs) for relapsing multiple sclerosis (MS). While clinical trials have established the efficacy and safety of both agents, less is known about their performance and resource utilization in the real-world setting.
Objective: To compare the real-world performance and resource utilization of FTY and DMF among patients with relapsing MS.
Methods: Consecutive patients treated with FTY or DMF with available 12-month follow-up were retrospectively identified from the Swedish MS Center in Seattle, Washington. Patient demographic and MS characteristics were extracted from the medical record. Primary outcome was the discontinuation of index therapy. Secondary outcomes included time to and reason for discontinuation, as well as clinic resource utilization, defined as the number of clinic visits, phone calls, and lab tests. Chi-square, t-test, and Cox proportional hazard model were used to assess differences between two cohorts.
Results: A total of 338 patients prescribed FTY (n=169) and DMF (n=169) were included in this study. At baseline, FTY cohort had longer MS disease duration (10.7 vs. 7.3 years; p=0.003) and slower timed 25-foot walk (6.7 vs. 5.5 sec; p=0.014); they were more likely to be treatment-experienced (94% vs. 83%; p=0.001) and stop prior DMT due to disease activity (39% vs. 25%; p=0.001) compared to DMF cohort. Overall discontinuation rate was low (13%, or 44 patients). Patients on DMF had numerically higher rate of treatment discontinuation (15% vs. 11%; p=0.196), but significantly greater number of phone calls (annualized mean+/-SD: 4.3+/-5.7 vs 3.4+/-3.8, p< 0.001), mostly due to greater number of clinic-initiated calls (1.3+/-1.5 vs. 1.0+/-1.9; p< 0.001). The leading reason for treatment discontinuation was tolerability in both groups; tolerability issue was reported more commonly in patients on DMF (13%) compared to patients on FTY (7%; p=0.044).
Conclusions: Our study suggests that patients on FTY in real-world setting have more advanced MS at treatment initiation compared to patients on DMF. In contrast to other single-center studies we did not find the difference in discontinuation rates between FTY and DMF, possibly because of the overall low discontinuation rate. In keeping with previous studies, our results suggest better tolerability profile of FTY compared to DMF in the real-world setting.
Disclosure:
P. Repovic: received compensation as consultant and/or speaker from Acorda, Biogen, EMD Serono, Genzyme, and Teva.
Y. Park: employee of University of Maryland.
V. Herrera: employee of Novartis.
Source of funding: Novartis.
Abstract: P375
Type: Poster
Abstract Category: Clinical aspects of MS - Economic burden
Background: Fingolimod (FTY) and dimethyl fumarate (DMF) are two commonly used oral disease modifying therapies (DMTs) for relapsing multiple sclerosis (MS). While clinical trials have established the efficacy and safety of both agents, less is known about their performance and resource utilization in the real-world setting.
Objective: To compare the real-world performance and resource utilization of FTY and DMF among patients with relapsing MS.
Methods: Consecutive patients treated with FTY or DMF with available 12-month follow-up were retrospectively identified from the Swedish MS Center in Seattle, Washington. Patient demographic and MS characteristics were extracted from the medical record. Primary outcome was the discontinuation of index therapy. Secondary outcomes included time to and reason for discontinuation, as well as clinic resource utilization, defined as the number of clinic visits, phone calls, and lab tests. Chi-square, t-test, and Cox proportional hazard model were used to assess differences between two cohorts.
Results: A total of 338 patients prescribed FTY (n=169) and DMF (n=169) were included in this study. At baseline, FTY cohort had longer MS disease duration (10.7 vs. 7.3 years; p=0.003) and slower timed 25-foot walk (6.7 vs. 5.5 sec; p=0.014); they were more likely to be treatment-experienced (94% vs. 83%; p=0.001) and stop prior DMT due to disease activity (39% vs. 25%; p=0.001) compared to DMF cohort. Overall discontinuation rate was low (13%, or 44 patients). Patients on DMF had numerically higher rate of treatment discontinuation (15% vs. 11%; p=0.196), but significantly greater number of phone calls (annualized mean+/-SD: 4.3+/-5.7 vs 3.4+/-3.8, p< 0.001), mostly due to greater number of clinic-initiated calls (1.3+/-1.5 vs. 1.0+/-1.9; p< 0.001). The leading reason for treatment discontinuation was tolerability in both groups; tolerability issue was reported more commonly in patients on DMF (13%) compared to patients on FTY (7%; p=0.044).
Conclusions: Our study suggests that patients on FTY in real-world setting have more advanced MS at treatment initiation compared to patients on DMF. In contrast to other single-center studies we did not find the difference in discontinuation rates between FTY and DMF, possibly because of the overall low discontinuation rate. In keeping with previous studies, our results suggest better tolerability profile of FTY compared to DMF in the real-world setting.
Disclosure:
P. Repovic: received compensation as consultant and/or speaker from Acorda, Biogen, EMD Serono, Genzyme, and Teva.
Y. Park: employee of University of Maryland.
V. Herrera: employee of Novartis.
Source of funding: Novartis.