Comparative treatment effectiveness of oral fingolimod and conventional injectable disease-modifying agents in multiple sclerosis

Study Objective To compare the effectiveness of oral fingolimod and conventional injectable disease-modifying agents (DMAs) using the composite endpoint of relapse or DMA treatment switch in patients with multiple sclerosis (MS). Design A retrospective longitudinal cohort study. Data Source IBM MarketScan Commercial Claims and Encounters Database from 2010-2012. Patients Adults (>= 18 years) with MS diagnosis (ICD-9-CM:340) who newly initiated DMAs. Intervention Oral fingolimod and conventional injectable DMAs (interferon beta and glatiramer acetate). Measurements Composite endpoint of time to relapse or DMA treatment switch. Main Results The incident study cohort consisted of 1997 MS patients who initiated oral fingolimod (15.6%) or injectable (84.4%) DMAs. The proportion of patients who had a composite endpoint (relapse/DMA treatment switch) in oral fingolimod and injectable DMA users was found to be 16.72% and 27.16%, respectively. The Cox PH regression model with stabilized IPTW revealed that fingolimod is equally effective as conventional injectable DMAs in reducing the risk of experiencing the composite endpoint of relapse or DMA switch (adjusted hazard ratio [aHR]: 0.67, 95% CI: 0.43-1.03). Additional analysis among patients who were adherent also found no significant difference in the composite endpoint (aHR: 0.70, 95% CI 0.49-1.15) between oral fingolimod and injectable DMA users. Conclusions Oral fingolimod has similar effectiveness as conventional injectable DMAs in reducing the risk of experiencing the composite endpoint (relapse or DMA treatment switch). In addition, when assessed independently, oral fingolimod showed no difference in reducing the time to relapse or DMA treatment switch compared to injectable DMAs.