Comparison of Fingolimod and Dimethyl Fumarate in the Treatment of Multiple Sclerosis: One Year Experience (P3.244)

OBJECTIVE: To compare the first year experience of fingolimod(FTY) and dimethyl fumarate(DMF) including discontinuation rates, efficacy, and tolerability. BACKGROUND: DMF and FTY are the two most commonly used oral agents for the treatment of relapsing MS becoming available in 2010 and 2013, respectively. There is limited comparative effectiveness data after one year of treatment. DESIGN/METHODS: Patients prescribed DMF or FTY at the Rocky Mountain MS Center at Anschutz Medical Campus (University of Colorado) prior to November 2013 who had the potential to complete one year of treatment were identified. Clinician reported data including relapse history, adverse events, medications, MRI outcomes, disease history and patient characteristics were retrospectively collected from electronic medical records. To balance the groups, logistic regression was used to examine outcomes adjusting for age, disease duration, gender, progressive disease and transition from natalizumab, where specified. RESULTS: A total of 281 and 382 patients initiated FTY and DMF at our center. At ≤12 months, 18.9[percnt] and 25.1[percnt] discontinued FTY and DMF respectively for any reason with an unadjusted risk ratio(RR) of 0.75 (95[percnt]CI 0.56-1.01, p=0.056) and adjusted RR of 0.75 (95[percnt]CI 0.55-1.03, p=0.069). Discontinuation due to adverse events was lower for FTY (12.1[percnt]) compared to DMF (17.5[percnt]) (RR0.69, 95[percnt]CI 0.47-1.01, p=0.054). The second leading discontinuation cause was disease activity (3.6[percnt] in FTY; 5.5[percnt] in DMF) (RR 0.65, 95[percnt]CI 0.31-1.35, p=0.24). Patients who discontinued at ≤12 months had median times to discontinuation of 3 and 4 months for DMF and FTY, respectively. CONCLUSIONS: Although none of the differences were statistically significant, there is a trend toward improved outcomes with FTY over DMF with MS patients on DMF being 33[percnt] more likely to discontinue drug at one year than FTY. This difference appears to be mainly driven by adverse events. Longer evaluation of this cohort will better help assess these differences. Disclosure: Dr. Vollmer has nothing to disclose. Dr. Seibert has nothing to disclose. Dr. Sillou has nothing to disclose. Dr. Dowdle has nothing to disclose. Dr. Corboy has received personal compensation for activities with ProCE, Celgene, Teva, Novartis, and Biogen Idec. Dr. Vollmer has received personal compensation for activities with Acorda Therapeutics, Biogen Idec, Genentech, Inc., Novartis, Ono Pharmaceutical, Teva Neuroscience, and XenoPort as a consultant. Dr. Nair has received compensation from Janssen Pharmaceuticals and Biogen Idec as a consultant. Dr. Alvarez has received personal compensation for activities with Teva Neuroscience.