Efficacy and Tolerability of Oral Disease Modifying Therapies in Clinical Practice

Background: The advent of oral disease modifying therapies (DMTs) has fundamentally changed the treatment of multiple sclerosis (MS). Nevertheless, impressions of their relative efficacy and tolerability are primarily founded on expert opinion.

Objectives: To determine whether oral DMTs were better tolerated and/or more effective for controlling MS when compared to injectable therapies (INJ) in clinical practice.

Methods: Single-center, retrospective cohort study. 494 patients initiating oral (fingolimod [FGD], teriflunomide [TER], or dimethyl fumarate [DMF]) or INJ therapy between March 2013 and March 2015 were enrolled and followed for 5-31 months. Outcomes included on-drug MS activity, drug discontinuation, and reasons for discontinuing therapy. Propensity-weighted matching was used to compare each oral DMT with INJ.

Results: 32-46% of patients initiating DMT ultimately discontinued or switched treatments during the study. After propensity matching, discontinuation rates were comparable across groups. Breakthrough MS was equally prevalent for FGD and DMF-treated compared to INJ-treated patients. However, a higher proportion of TER-treated patients experienced MS activity compared to those treated with INJ (p=0.012).

Conclusions: In this cohort, oral DMTs did not improve patient retention compared to INJ. Moreover, in this observational study, TER appeared less effective than INJ DMTs. Further study is needed to confirm these findings.