Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis

Tomas Kalincik, Eva Kubala Havrdova, Dana Horakova, Guillermo Izquierdo, Alexandre Prat, Marc Girard, Pierre Duquette, Pierre Grammond, Marco Onofrj, Alessandra Lugaresi, Serkan Ozakbas, Ludwig Kappos, Jens Kuhle, Murat Terzi, Jeannette Lechner-Scott, Cavit Boz, Francois Grand'maison, Julie Prevost, Patrizia Sola, Diana FerraroFranco Granella, Maria Trojano, Roberto Bergamaschi, Eugenio Pucci, Recai Turkoglu, Pamela A. McCombe, Vincent Van Pesch, Bart Van Wijmeersch, Claudio Solaro, Cristina Ramo-Tello, Mark Slee, Raed Alroughani, Bassem Yamout, Vahid Shaygannejad, Daniele Spitaleri, José Luis Sánchez-Menoyo, Radek Ampapa, Suzanne Hodgkinson, Rana Karabudak, Ernest Butler, Steve Vucic, Vilija Jokubaitis, Tim Spelman, Helmut Butzkueven

Research output: Contribution to journalArticlepeer-review

52 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)458-468
Number of pages11
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number4
Publication statusPublished - 1 Apr 2019


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