Multiple sclerosis and related disorders · 2026
Comparative assessment of treatment switching in patients with multiple sclerosis receiving cladribine tablets versus fingolimod, dimethyl fumarate, and teriflunomide.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Lobo Carroline, Rey Gabriel Gomez, Zhao Xin, Anderson Jeffrey, Kim Sonia, Kozma Chris, Cai Chao, Evans Emily, Phillips Amy L, Chen Xiaoxue
Аннотация
BACKGROUND: Comparative data on cladribine tablets (CladT) versus other disease modifying therapies (DMTs) for multiple sclerosis (MS) in the United States (US) are limited. We compared treatment switching and time-to-switch within 1- and 2-year follow-ups between CladT-treated and fingolimod-, dimethyl fumarate-, or teriflunomide-treated patients with MS.
METHODS: Data for this retrospective observational study were sourced from the Komodo Healthcare Map™ database and included patients aged ≥18 years in the US with ≥2 MS diagnoses ≥30 days apart; ≥1 claim for CladT, fingolimod, dimethyl fumarate, or teriflunomide between 1 April 2019, and 31 December 2020 (initiation date = index); no index DMT in the year prior to the index date (baseline); and continuous enrollment in healthcare insurance from baseline to 2 years after the index date (follow-up). Propensity score weighting with covariate adjusted logistic regression, Kaplan-Meier and Cox regression were employed to assess switching outcomes between groups.
RESULTS: Eligible patients (n = 4709) treated with CladT (n = 269), dimethyl fumarate (n = 2314), fingolimod (n = 677), and teriflunomide (n = 1449) were identified from the database. CladT-treated patients were less likely to switch treatment during the 2-year follow-up (10%) compared to fingolimod- (27%), dimethyl fumarate- (44%), or teriflunomide-treated (34%) patients in the weighted cohorts. The adjusted odds ratios (95% confidence interval [CI]) for treatment switching at 2 years were 3.25 (2.03-5.32), 6.75 (4.29-10.92), and 4.65 (2.92-7.59) for fingolimod, dimethyl fumarate, and teriflunomide, respectively, relative to CladT. Cox regression results suggested significant differences in time-to-switch compared to CladT, with hazard ratios of 2.99 (95% CI: 1.89-4.71) for fingolimod, 5.45 (95% CI: 3.73-7.97) for dimethyl fumarate, and 4.06 (95% CI: 2.73-6.06) for teriflunomide.
CONCLUSION: This real-world study revealed significantly lower treatment switching rates in CladT-treated patients than in fingolimod-, dimethyl fumarate- and teriflunomide-treated patients with MS.
METHODS: Data for this retrospective observational study were sourced from the Komodo Healthcare Map™ database and included patients aged ≥18 years in the US with ≥2 MS diagnoses ≥30 days apart; ≥1 claim for CladT, fingolimod, dimethyl fumarate, or teriflunomide between 1 April 2019, and 31 December 2020 (initiation date = index); no index DMT in the year prior to the index date (baseline); and continuous enrollment in healthcare insurance from baseline to 2 years after the index date (follow-up). Propensity score weighting with covariate adjusted logistic regression, Kaplan-Meier and Cox regression were employed to assess switching outcomes between groups.
RESULTS: Eligible patients (n = 4709) treated with CladT (n = 269), dimethyl fumarate (n = 2314), fingolimod (n = 677), and teriflunomide (n = 1449) were identified from the database. CladT-treated patients were less likely to switch treatment during the 2-year follow-up (10%) compared to fingolimod- (27%), dimethyl fumarate- (44%), or teriflunomide-treated (34%) patients in the weighted cohorts. The adjusted odds ratios (95% confidence interval [CI]) for treatment switching at 2 years were 3.25 (2.03-5.32), 6.75 (4.29-10.92), and 4.65 (2.92-7.59) for fingolimod, dimethyl fumarate, and teriflunomide, respectively, relative to CladT. Cox regression results suggested significant differences in time-to-switch compared to CladT, with hazard ratios of 2.99 (95% CI: 1.89-4.71) for fingolimod, 5.45 (95% CI: 3.73-7.97) for dimethyl fumarate, and 4.06 (95% CI: 2.73-6.06) for teriflunomide.
CONCLUSION: This real-world study revealed significantly lower treatment switching rates in CladT-treated patients than in fingolimod-, dimethyl fumarate- and teriflunomide-treated patients with MS.