Real-world persistence to first-line DMTs in relapsing-remitting multiple sclerosis

• Published in: Multiple sclerosis and related disorders Vol. 78; p. 104909
• Main Authors: López-Caneda, Clara, Pérez-Haro, María José, Sánchez-Franco, César, Álvarez-Rodríguez, Elena, Aguado-Valcárcel, Marta, Marcos-Bobillo, María, González-Suarez, Inés
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.10.2023
• Subjects: Discontinuation; Disease-modifying therapies; Observational study; Relapsing-remitting multiple sclerosis; Treatment persistence; Relapsing-remitting multiple sclerosis; Observational study; Discontinuation; Treatment persistence; Disease-modifying therapies
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2023.104909

•The paper presents a comparative study of first-line disease-modifying treatments (DMT) for multiple sclerosis (MS) in a real-world setting, which is valuable as no head-to-head studies are currently available.•The primary outcome of the study is the median time to discontinuation of any DMT, and the results show that there is no significant difference in persistence between teriflunomide, dimethyl fumarate, and injectable drugs. While there is no significant difference in persistence between DMT, there is a trend towards favoring oral DMT over injectable drugs.•The most frequent reason for discontinuation differs within groups, with lack of efficacy being the primary reason for teriflunomide, and adverse effects being the primary reason for dimethyl fumarate and injectable drugs.•A trend towards early treatment and lower EDSS scores was observed after 2018, particularly in the teriflunomide group, suggesting a shift towards more aggressive and proactive MS management. disease-modifying treatments (DMT) for Multiple Sclerosis (MS) have expanded in recent years making the shared-decision process challenging. Moreover, no head-to-head studies are available within the first-line options. Our aim is to compare therapeutic persistence within first-line DMT: teriflunomide (TER), dimethyl fumarate (DMF), and injectable drugs (INJ) in a real-world setting. Retrospective observational study analyzing diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) who started DMT between January 2015 and April 2022 (TER=117, DMF=117, INJ=123). Clinical, radiological, and demographic variables were collected. The primary outcome was the median time to discontinuation of any DMT. Dropout was defined as discontinuation for 6 months for any reason. Of the total of 357 patients, 155 withdraw with a median time-to-discontinuation of 1.427 years (IQR 2.410). The discontinuation rate was higher in the injectable group, 49.6%; compared to teriflunomide 40.2%, and dimethyl fumarate 39.8% (p = 0.201). The most frequent reason of discontinuation differs within groups (lack of efficacy in TER, 63.8%, and adverse effects in DMF and INJ (40.4% and 40.9% respectively). No difference in persistence was observed between DMT (p = 0.30). After 2018 there has been a tendency to treat in a quick and early manner (lower EDSS; relapse rate and number of naïve patients), statistically significant for TER (p = 0.005, p = 0.010, and p = 0.045). Our study demonstrated no differences in persistence between the actual first-line DMT in a real-world setting, although a trend to favor oral-DMT was seen. Reasons for discontinuation differs within groups.