PT  - JOURNAL ARTICLE
AU  - Kalincik, Tomas
AU  - Kubala Havrdova, Eva
AU  - Horakova, Dana
AU  - Izquierdo, Guillermo
AU  - Prat, Alexandre
AU  - Girard, Marc
AU  - Duquette, Pierre
AU  - Grammond, Pierre
AU  - Onofrj, Marco
AU  - Lugaresi, Alessandra
AU  - Ozakbas, Serkan
AU  - Kappos, Ludwig
AU  - Kuhle, Jens
AU  - Terzi, Murat
AU  - Lechner-Scott, Jeannette
AU  - Boz, Cavit
AU  - Grand'Maison, Francois
AU  - Prevost, Julie
AU  - Sola, Patrizia
AU  - Ferraro, Diana
AU  - Granella, Franco
AU  - Trojano, Maria
AU  - Bergamaschi, Roberto
AU  - Pucci, Eugenio
AU  - Turkoglu, Recai
AU  - McCombe, Pamela A
AU  - Pesch, Vincent Van
AU  - Van Wijmeersch, Bart
AU  - Solaro, Claudio
AU  - Ramo-Tello, Cristina
AU  - Slee, Mark
AU  - Alroughani, Raed
AU  - Yamout, Bassem
AU  - Shaygannejad, Vahid
AU  - Spitaleri, Daniele
AU  - Sánchez-Menoyo, José Luis
AU  - Ampapa, Radek
AU  - Hodgkinson, Suzanne
AU  - Karabudak, Rana
AU  - Butler, Ernest
AU  - Vucic, Steve
AU  - Jokubaitis, Vilija
AU  - Spelman, Tim
AU  - Butzkueven, Helmut
TI  - Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis
AID  - 10.1136/jnnp-2018-319831
DP  - 2019 Apr 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 458--468
VI  - 90
IP  - 4
4099  - http://jnnp.bmj.com/content/90/4/458.short
4100  - http://jnnp.bmj.com/content/90/4/458.full
SO  - J Neurol Neurosurg Psychiatry2019 Apr 01; 90
AB  - Objective Oral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed.Methods We identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring).Results The eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68).Conclusion The effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.