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.