Time to treatment failure following initiation of fingolimod versus teriflunomide for multiple sclerosis: a retrospective US claims study
- 5 December 2019
- journal article
- research article
- Published by Taylor & Francis Ltd in Current Medical Research and Opinion
- Vol. 36 (2), 261-270
- https://doi.org/10.1080/03007995.2019.1690440
Abstract
Objective: Disease modifying therapies (DMTs) for multiple sclerosis (MS) aim to delay progression and reduce relapses. Evidence is limited on the comparative effectiveness of the oral DMTs fingolimod and teriflunomide. This study evaluated time to treatment failure among patients with MS who initiated fingolimod versus teriflunomide in real-world settings. Methods: The retrospective cohort included 18–64 year old patients diagnosed with MS who initiated fingolimod or teriflunomide during 9/12/2012–9/30/2015 within MarketScan Commercial and Medicare Claims. Patients were followed from treatment initiation (index date) until first treatment failure or censoring. Treatment failure was defined as the first occurrence of MS relapse (identified using a validated algorithm) or treatment discontinuation (≥60-day supply gap). Treatment failure was examined through Kaplan-Meier analysis and multivariable Cox regression adjusting for 1-year baseline factors (age, gender, plan type, region, index year, prior DMT use, baseline relapses, Charlson comorbidity index [CCI], and MS symptoms). Results: On average, patients treated with fingolimod (n = 2,704) were younger (43.6 versus 49.8 years) with lower CCI (0.4 versus 0.7) and more relapses at baseline (0.46 versus 0.42) than those treated with teriflunomide (n = 1,859). Median time to treatment failure was 19.5 months with fingolimod versus 9.6 months with teriflunomide (p < 0.001). After controlling key demographic and clinical characteristics through multivariable regression, fingolimod was associated with 38.9% lower hazards of treatment failure versus teriflunomide (adjusted hazard ratio =0.611; 95% CI: 0.559-0.669; p < 0.001). Conclusions: In a large cohort of U.S. adults with MS, controlling for key baseline characteristics, fingolimod was associated with significantly longer time to treatment failure and lower risk of treatment failure compared with teriflunomide.Keywords
This publication has 27 references indexed in Scilit:
- Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trialThe Lancet Neurology, 2014
- Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trialThe Lancet Neurology, 2014
- Relapse Rates in Patients with Multiple Sclerosis Switching from Interferon to Fingolimod or Glatiramer Acetate: A US Claims Database StudyPLOS ONE, 2014
- Teriflunomide versus subcutaneous interferon beta-1a in patients with relapsing multiple sclerosis: a randomised, controlled phase 3 trialMultiple Sclerosis Journal, 2013
- Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort studyBMC Neurology, 2013
- Randomized Trial of Oral Teriflunomide for Relapsing Multiple SclerosisThe New England Journal of Medicine, 2011
- Current Disease‐Modifying Treatment of Multiple SclerosisMount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 2011
- A Placebo-Controlled Trial of Oral Fingolimod in Relapsing Multiple SclerosisThe New England Journal of Medicine, 2010
- Oral Fingolimod or Intramuscular Interferon for Relapsing Multiple SclerosisThe New England Journal of Medicine, 2010
- Methods for evaluation of medication adherence and persistence using automated databasesPharmacoepidemiology and Drug Safety, 2006