Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis

David-Axel Laplaud 1, * Romain Casey 2 Laetitia Barbin 3 Marc Debouverie 4 Jerome de Sèze 5 David Brassat 6 Sandrine Wiertlewski 7 Bruno Brochet 8 Jean Pelletier 9 Patrick Vermersch 10 Gilles Edan 11 Christine Lebrun-Frenay 12 Pierre Clavelou 13 Eric Thouvenot 14 Jean-Philippe Camdessanché 15 Ayman Tourbah 16 Bruno Stankoff 17 Abdullatif Al Khedr 18 Philippe Cabre 19 Catherine Lubetzki 20 Caroline Papeix 21 Eric Berger 22 Olivier Heinzlef 23 Thomas Debroucker 24 Thibault Moreau 25 Olivier Gout 26 Bertrand Bourre 27 Abir Wahab Pierre Labauge 28 Laurent Magy 29 Gilles Defer 30 Anne-Marie Guennoc Nicolas Maubeuge Céline Labeyrie 31 Ivania Patry Chantal Nifle Olivier Casez 14 Laure Michel 1 Fabien Rollot 32 Emmanuelle Leray 33 Sandra Vukusic 5 Yohann Foucher 34
* Corresponding author
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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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, American Academy of Neurology, 2019, 93 (7), pp.e635-e646. ⟨10.1212/WNL.0000000000007938⟩. ⟨inserm-02289153⟩

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