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Published in: Journal of Neurology 2/2019

01-02-2019 | Original Communication

Discontinuation of teriflunomide and dimethyl fumarate in a large Italian multicentre population: a 24-month real-world experience

Authors: E. D’Amico, A. Zanghì, M. Sciandra, G. Borriello, G. Callari, A. Gallo, G. Salemi, S. Cottone, M. Buccafusca, P. Valentino, R. B. Bossio, L. M. E. Grimaldi, C. Pozzilli, G. Tedeschi, M. Zappia, F. Patti

Published in: Journal of Neurology | Issue 2/2019

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Abstract

Background

Teriflunomide (TRF) and Dimethyl fumarate (DMF) are licensed drugs for relapsing-remitting Multiple Sclerosis (RRMS).

Objectives

We aimed to compare the rate and the time to discontinuation among persons with RRMS (pwRRMS), newly treated with TRF and DMF.

Materials and methods

A retrospective study on prospectively collected data was performed in nine tertiary MS centers, in Italy. The 24-month discontinuation rate in the two cohorts was the primary study outcome. We also assessed the time to discontinuation and reasons of therapy withdrawn. Discontinuation of TRF and DMF was defined as a gap of treatment ≥ 60 days.

Results

A cohort of 903 pwRRMS (316 on TRF and 587 on DMF) was analyzed. During 24 months of follow-up, pwRRMS on TRF and DMF showed similar discontinuation rates. The analysis of predictors with Cox regression model showed differences between the two groups (p for log-rank test = 0.007); male gender [HR 2.21 (1.00–4.90); p = 0.01] and the number of previous switches [HR 1.47 (1.16–1.86); p = 0.01] were associated with higher hazard of discontinuation in the DMF group.

Conclusions

In a real-world setting, pwRRMS on TRF and DMF had similar discontinuation rates over 24 months. Male pwRRMS on DMF with a previous history of therapeutic failure are at more risk of discontinuation therapy.
Literature
1.
2.
go back to reference D’Amico E, Zanghi A, Leone C, Tumani H, Patti F (2016) Treatment-related progressive multifocal leukoencephalopathy in multiple sclerosis: a comprehensive review of current evidence and future needs. Drug Saf 39(12):1163–1174CrossRefPubMed D’Amico E, Zanghi A, Leone C, Tumani H, Patti F (2016) Treatment-related progressive multifocal leukoencephalopathy in multiple sclerosis: a comprehensive review of current evidence and future needs. Drug Saf 39(12):1163–1174CrossRefPubMed
3.
go back to reference D’Amico E, Leone C, Caserta C, Patti F (2015) Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal. Expert Rev Neurother 15(7):803–824CrossRefPubMed D’Amico E, Leone C, Caserta C, Patti F (2015) Oral drugs in multiple sclerosis therapy: an overview and a critical appraisal. Expert Rev Neurother 15(7):803–824CrossRefPubMed
4.
go back to reference D’Amico E, Patti F, Zanghi A, Zappia M (2016) A personalized approach in progressive multiple sclerosis: the current status of disease modifying therapies (DMTs) and future perspectives. Int J Mol Sci 17(10):1725CrossRefPubMedCentral D’Amico E, Patti F, Zanghi A, Zappia M (2016) A personalized approach in progressive multiple sclerosis: the current status of disease modifying therapies (DMTs) and future perspectives. Int J Mol Sci 17(10):1725CrossRefPubMedCentral
5.
go back to reference Eichler HG, Abadie E, Breckenridge A, Flamion B, Gustafsson LL, Leufkens H et al (2011) Bridging the efficacy–effectiveness gap: a regulator’s perspective on addressing variability of drug response. Nat Rev Drug Discov 10(7):495–506CrossRefPubMed Eichler HG, Abadie E, Breckenridge A, Flamion B, Gustafsson LL, Leufkens H et al (2011) Bridging the efficacy–effectiveness gap: a regulator’s perspective on addressing variability of drug response. Nat Rev Drug Discov 10(7):495–506CrossRefPubMed
6.
go back to reference Johnson KM, Zhou H, Lin F, Ko JJ, Herrera V (2017) Real-world adherence and persistence to oral disease-modifying therapies in multiple sclerosis patients over 1 year. J Manag Care Spec Pharm 23(8):844–852PubMed Johnson KM, Zhou H, Lin F, Ko JJ, Herrera V (2017) Real-world adherence and persistence to oral disease-modifying therapies in multiple sclerosis patients over 1 year. J Manag Care Spec Pharm 23(8):844–852PubMed
7.
go back to reference Lattanzi S, Danni M, Taffi R, Cerqua R, Carlini G, Pulcini A et al (2017) Persistence to oral disease-modifying therapies in multiple sclerosis patients. J Neurol 264(11):2325–2329CrossRefPubMed Lattanzi S, Danni M, Taffi R, Cerqua R, Carlini G, Pulcini A et al (2017) Persistence to oral disease-modifying therapies in multiple sclerosis patients. J Neurol 264(11):2325–2329CrossRefPubMed
8.
go back to reference Eriksson I, Cars T, Piehl F, Malmstrom RE, Wettermark B, von Euler M (2018) Persistence with dimethyl fumarate in relapsing-remitting multiple sclerosis: a population-based cohort study. Eur J Clin Pharmacol 74(2):219–226CrossRefPubMed Eriksson I, Cars T, Piehl F, Malmstrom RE, Wettermark B, von Euler M (2018) Persistence with dimethyl fumarate in relapsing-remitting multiple sclerosis: a population-based cohort study. Eur J Clin Pharmacol 74(2):219–226CrossRefPubMed
9.
go back to reference Ferraro D, Camera V, Baldi E, Vacchiano V, Curti E, Guareschi A et al (2018) First-line disease-modifying drugs in relapsing-remitting multiple sclerosis: an Italian real-life multicenter study on persistence. Curr Med Res Opin 1:1–5 Ferraro D, Camera V, Baldi E, Vacchiano V, Curti E, Guareschi A et al (2018) First-line disease-modifying drugs in relapsing-remitting multiple sclerosis: an Italian real-life multicenter study on persistence. Curr Med Res Opin 1:1–5
10.
go back to reference Sejbaek T, Nybo M, Petersen T, Illes Z (2018) Real-life persistence and tolerability with dimethyl fumarate. Mult Scler Relat Disord 24:42–46CrossRefPubMed Sejbaek T, Nybo M, Petersen T, Illes Z (2018) Real-life persistence and tolerability with dimethyl fumarate. Mult Scler Relat Disord 24:42–46CrossRefPubMed
11.
go back to reference Vollmer B, Ontaneda D, Bandyopadhyay A, Cohn S, Nair K, Sillau S et al (2018) Discontinuation and comparative effectiveness of dimethyl fumarate and fingolimod in 2 centers. Neurol Clin Pract 8(4):292–301CrossRefPubMedPubMedCentral Vollmer B, Ontaneda D, Bandyopadhyay A, Cohn S, Nair K, Sillau S et al (2018) Discontinuation and comparative effectiveness of dimethyl fumarate and fingolimod in 2 centers. Neurol Clin Pract 8(4):292–301CrossRefPubMedPubMedCentral
12.
go back to reference Mallucci G, Annovazzi P, Miante S, Torri-Clerici V, Matta M, La Gioia S et al (2018) Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study. J Neurol 265(8):1850–1859CrossRefPubMed Mallucci G, Annovazzi P, Miante S, Torri-Clerici V, Matta M, La Gioia S et al (2018) Two-year real-life efficacy, tolerability and safety of dimethyl fumarate in an Italian multicentre study. J Neurol 265(8):1850–1859CrossRefPubMed
13.
go back to reference Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302CrossRefPubMedPubMedCentral Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M et al (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302CrossRefPubMedPubMedCentral
14.
go back to reference D’Amico E, Zanghì A, Callari G, Borriello G, Gallo A, Graziano G et al (2018) Comparable efficacy and safety of dimethyl fumarate and teriflunomide treatment in relapsing-remitting multiple sclerosis: an Italian real-word multicenter experience. Ther Adv Neurol Disord 11:1756286418796404CrossRef D’Amico E, Zanghì A, Callari G, Borriello G, Gallo A, Graziano G et al (2018) Comparable efficacy and safety of dimethyl fumarate and teriflunomide treatment in relapsing-remitting multiple sclerosis: an Italian real-word multicenter experience. Ther Adv Neurol Disord 11:1756286418796404CrossRef
16.
go back to reference Confavreux C, O’Connor P, Comi G, Freedman MS, Miller AE, Olsson TP et al (2014) Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 13(3):247–256CrossRefPubMed Confavreux C, O’Connor P, Comi G, Freedman MS, Miller AE, Olsson TP et al (2014) Oral teriflunomide for patients with relapsing multiple sclerosis (TOWER): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 13(3):247–256CrossRefPubMed
17.
go back to reference Fox RJ, Miller DH, Phillips JT, Hutchinson M, Havrdova E, Kita M et al (2012) Placebo-controlled phase 3 study of oral BG-12 or glatiramer in multiple sclerosis. N Engl J Med 367(12):1087–1097CrossRef Fox RJ, Miller DH, Phillips JT, Hutchinson M, Havrdova E, Kita M et al (2012) Placebo-controlled phase 3 study of oral BG-12 or glatiramer in multiple sclerosis. N Engl J Med 367(12):1087–1097CrossRef
18.
go back to reference Gold R, Kappos L, Arnold DL, Bar-Or A, Giovannoni G, Selmaj K et al (2012) Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N Engl J Med 367(12):1098–1107CrossRefPubMed Gold R, Kappos L, Arnold DL, Bar-Or A, Giovannoni G, Selmaj K et al (2012) Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis. N Engl J Med 367(12):1098–1107CrossRefPubMed
19.
go back to reference O’Connor P, Comi G, Freedman MS, Miller AE, Kappos L, Bouchard JP et al (2016) Long-term safety and efficacy of teriflunomide: nine-year follow-up of the randomized TEMSO study. Neurology 86(10):920–930CrossRefPubMedPubMedCentral O’Connor P, Comi G, Freedman MS, Miller AE, Kappos L, Bouchard JP et al (2016) Long-term safety and efficacy of teriflunomide: nine-year follow-up of the randomized TEMSO study. Neurology 86(10):920–930CrossRefPubMedPubMedCentral
20.
go back to reference Lugaresi A, Rottoli MR, Patti F (2014) Fostering adherence to injectable disease-modifying therapies in multiple sclerosis. Expert Rev Neurother 14(9):1029–1042CrossRefPubMed Lugaresi A, Rottoli MR, Patti F (2014) Fostering adherence to injectable disease-modifying therapies in multiple sclerosis. Expert Rev Neurother 14(9):1029–1042CrossRefPubMed
21.
go back to reference Theodore Phillips J, Erwin AA, Agrella S, Kremenchutzky M, Kramer JF, Darkes MJ et al (2015) Consensus management of gastrointestinal events associated with delayed-release dimethyl fumarate: a Delphi study. Neurol Ther 4(2):137–146CrossRefPubMedPubMedCentral Theodore Phillips J, Erwin AA, Agrella S, Kremenchutzky M, Kramer JF, Darkes MJ et al (2015) Consensus management of gastrointestinal events associated with delayed-release dimethyl fumarate: a Delphi study. Neurol Ther 4(2):137–146CrossRefPubMedPubMedCentral
22.
go back to reference Ziemssen T, Kern R, Thomas K (2016) Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach. BMC Neurol 16(1):124CrossRefPubMedPubMedCentral Ziemssen T, Kern R, Thomas K (2016) Multiple sclerosis: clinical profiling and data collection as prerequisite for personalized medicine approach. BMC Neurol 16(1):124CrossRefPubMedPubMedCentral
Metadata
Title
Discontinuation of teriflunomide and dimethyl fumarate in a large Italian multicentre population: a 24-month real-world experience
Authors
E. D’Amico
A. Zanghì
M. Sciandra
G. Borriello
G. Callari
A. Gallo
G. Salemi
S. Cottone
M. Buccafusca
P. Valentino
R. B. Bossio
L. M. E. Grimaldi
C. Pozzilli
G. Tedeschi
M. Zappia
F. Patti
Publication date
01-02-2019
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 2/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-018-9144-9

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