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Journal Articles Neurology Year : 2019

Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis

1 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
2 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
3 CIC Nantes - Centre d’Investigation Clinique de Nantes
4 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
5 Service de Neurologie [Lyon]
6 CPTP - Centre de Physiopathologie Toulouse Purpan
7 Service de Neurologie
8 Service de neurologie [Bordeaux]
9 CRMBM - Centre de résonance magnétique biologique et médicale
10 Inflammation: mécanismes et régulation et interactions avec la nutrition et les candidoses
11 Service de neurologie [Rennes]
12 Department of Neurology
13 Service de Neurologie [CHU Clermont-Ferrand]
14 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
15 Service de Neurologie
16 Service de neurologie [Reims]
17 ICM - Institut du Cerveau = Paris Brain Institute
18 CHU Saint-Antoine [AP-HP]
19 Department of Neurology
20 CHU Pitié-Salpêtrière [AP-HP]
21 Public Health Agency of Canada
22 CHI Poissy-Saint-Germain
23 Service de Neurologie [CHU de Poissy]
24 Service de Neurologie générale, vasculaire et dégénérative (CHU de Dijon)
25 CERCRID - Centre de Recherches Critiques sur le Droit
26 Service de Neurologie
27 Département de neurologie [Montpellier]
28 Service de Neurologie [CHU Limoges]
29 Service de Neurologie [CHU Caen]
30 Hôpital Bicêtre
31 LNC - Lipides - Nutrition - Cancer (U866)
32 EHESP - École des Hautes Études en Santé Publique [EHESP]
33 AIDMP - Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415
Bruno Brochet
  • Function : Author
  • PersonId : 898575
Gilles Edan
  • Function : Author
  • PersonId : 838812
Christine Lebrun-Frenay
Eric Thouvenot
Jean-Philippe Camdessanché
Bruno Stankoff
Caroline Papeix
Abir Wahab
  • Function : Author
Pierre Labauge
Laurent Magy
Anne-Marie Guennoc
  • Function : Author
Nicolas Maubeuge
  • Function : Author
Ivania Patry
  • Function : Author
Chantal Nifle
  • Function : Author
Sandra Vukusic

Abstract

Objective: In this study, we compared the effectiveness of teriflunomide (TRF) and dimethyl fumarate (DMF) on both clinical and MRI outcomes in patients followed prospectively in the Observatoire Français de la Sclerose en Plaques.Methods: A total of 1,770 patients with relapsing-remitting multiple sclerosis (RRMS) (713 on TRF and 1,057 on DMF) with an available baseline brain MRI were included in intention to treat. The 1- and 2-year postinitiation outcomes were relapses, increase of T2 lesions, increase in Expanded Disability Status Scale score, and reason for treatment discontinuation. Propensity scores (inverse probability weighting) and logistic regressions were estimated.Results: The confounder-adjusted proportions of patients were similar in TRF- compared to DMF-treated patients for relapses and disability progression after 1 and 2 years. However, the adjusted proportion of patients with at least one new T2 lesion after 2 years was lower in DMF compared to TRF (60.8% vs 72.2%, odds ratio [OR] 0.60, p< 0.001). Analyses of reasons for treatment withdrawal showed that lack of effectiveness was reported for 8.5% of DMF-treated patients vs 14.5% of TRF-treated patients (OR 0.54, p< 0.001), while adverse events accounted for 16% of TRF-treated patients and 21% of DMF-treated patients after 2 years (OR 1.39, p< 0.001).Conclusions: After 2 years of treatment, we found similar effectiveness of DMF and TRF in terms of clinical outcomes, but with better MRI-based outcomes for DMF-treated patients, resulting in a lower rate of treatment discontinuation due to lack of effectiveness.
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Dates and versions

inserm-02289153 , version 1 (16-09-2019)

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David-Axel Laplaud, Romain Casey, Laetitia Barbin, Marc Debouverie, Jerome de Sèze, et al.. Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis. Neurology, 2019, 93 (7), pp.e635-e646. ⟨10.1212/WNL.0000000000007938⟩. ⟨inserm-02289153⟩
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