Multiple sclerosis (Houndmills, Basingstoke, England) · 2026
Time-dependent divergence in infection risks among patients with multiple sclerosis treated with fumarates versus anti-CD20 monoclonal antibodies.
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Smoot Kyle, Longbrake Erin E, Avila Mirla, Wesley Sarah F, Hentati Afif, Meador William, Scagnelli John, Lakin Lynsey L, Gudesblatt Mark, Bian Boyang, Mendoza Jason P, Belviso Nicholas, Lewin James B, Shankar Sai L, Obeidat Ahmed Z
Аннотация
BACKGROUND: People with multiple sclerosis (pwMS) treated with anti-CD20 monoclonal antibodies have an elevated infection risk, yet long-term comparative data with oral fumarates are limited.
OBJECTIVE: To compare infection incidence, healthcare resource utilization, and relapse outcomes among pwMS receiving fumarate or anti-CD20 therapy for ⩾2 years.
METHODS: This retrospective propensity-matched (1:2) analysis used US Komodo Health claims (1 January 2016-31 May 2022) for pwMS aged 18-64 years with ⩾2 years of continuous follow-up. Outcomes were assessed using Poisson generalized linear models.
RESULTS: A total of 1956 pwMS were matched (fumarates: n = 652; anti-CD20s: n = 1304), with mean follow-up ~3 years. By year 2, the fumarates group had a lower infection rate than anti-CD20s (rate ratio: 0.84; 95% CI: 0.73-0.97; p = 0.016), but the most substantial difference was observed in years 4+, where fumarate-treated patients had a 30% reduction versus anti-CD20s (rate ratio: 0.70; 95% CI: 0.52-0.95; p = 0.021).
CONCLUSIONS: Fumarate therapy was associated with a lower infection risk versus anti-CD20s. The infection rate in the fumarates group remained relatively stable over time, but it progressively increased in the anti-CD20 group, with the most prominent differences observed at year 4 and beyond.
OBJECTIVE: To compare infection incidence, healthcare resource utilization, and relapse outcomes among pwMS receiving fumarate or anti-CD20 therapy for ⩾2 years.
METHODS: This retrospective propensity-matched (1:2) analysis used US Komodo Health claims (1 January 2016-31 May 2022) for pwMS aged 18-64 years with ⩾2 years of continuous follow-up. Outcomes were assessed using Poisson generalized linear models.
RESULTS: A total of 1956 pwMS were matched (fumarates: n = 652; anti-CD20s: n = 1304), with mean follow-up ~3 years. By year 2, the fumarates group had a lower infection rate than anti-CD20s (rate ratio: 0.84; 95% CI: 0.73-0.97; p = 0.016), but the most substantial difference was observed in years 4+, where fumarate-treated patients had a 30% reduction versus anti-CD20s (rate ratio: 0.70; 95% CI: 0.52-0.95; p = 0.021).
CONCLUSIONS: Fumarate therapy was associated with a lower infection risk versus anti-CD20s. The infection rate in the fumarates group remained relatively stable over time, but it progressively increased in the anti-CD20 group, with the most prominent differences observed at year 4 and beyond.