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Journal Articles Neurology Year : 2019

Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis

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Bruno Brochet
  • Function : Author
  • PersonId : 898575
Gilles Edan
  • Function : Author
  • PersonId : 838812
Christine Lebrun-Frenay
Eric Thouvenot
Jean-Philippe Camdessanché
Bruno Stankoff
  • Function : Author
  • PersonId : 971642
Caroline Papeix
Olivier Gout
  • Function : Author
  • PersonId : 943109
Abir Wahab
  • Function : Author
Pierre Labauge
Laurent Magy
  • Function : Author
  • PersonId : 911059
Anne-Marie Guennoc
  • Function : Author
Nicolas Maubeuge
  • Function : Author
Ivania Patry
  • Function : Author
Chantal Nifle
  • Function : Author
Sandra Vukusic

Abstract

Objective: In this study, we compared the effectiveness of teriflunomide (TRF) and dimethyl fumarate (DMF) on both clinical and MRI outcomes in patients followed prospectively in the Observatoire Français de la Sclerose en Plaques.Methods: A total of 1,770 patients with relapsing-remitting multiple sclerosis (RRMS) (713 on TRF and 1,057 on DMF) with an available baseline brain MRI were included in intention to treat. The 1- and 2-year postinitiation outcomes were relapses, increase of T2 lesions, increase in Expanded Disability Status Scale score, and reason for treatment discontinuation. Propensity scores (inverse probability weighting) and logistic regressions were estimated.Results: The confounder-adjusted proportions of patients were similar in TRF- compared to DMF-treated patients for relapses and disability progression after 1 and 2 years. However, the adjusted proportion of patients with at least one new T2 lesion after 2 years was lower in DMF compared to TRF (60.8% vs 72.2%, odds ratio [OR] 0.60, p< 0.001). Analyses of reasons for treatment withdrawal showed that lack of effectiveness was reported for 8.5% of DMF-treated patients vs 14.5% of TRF-treated patients (OR 0.54, p< 0.001), while adverse events accounted for 16% of TRF-treated patients and 21% of DMF-treated patients after 2 years (OR 1.39, p< 0.001).Conclusions: After 2 years of treatment, we found similar effectiveness of DMF and TRF in terms of clinical outcomes, but with better MRI-based outcomes for DMF-treated patients, resulting in a lower rate of treatment discontinuation due to lack of effectiveness.
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inserm-02289153 , version 1 (16-09-2019)

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David-Axel Laplaud, Romain Casey, Laetitia Barbin, Marc Debouverie, Jerome de Sèze, et al.. Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis. Neurology, 2019, 93 (7), pp.e635-e646. ⟨10.1212/WNL.0000000000007938⟩. ⟨inserm-02289153⟩
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