| Abstrakt: |
BACKGROUND: Fumarates (FUMs) and sphingosine-1-phosphate receptor modulators (S1Ps) are oral disease-modifying therapies (DMTs) for the treatment of patients with relapsing multiple sclerosis (PwMS). Black patients are underrepresented in clinical trials, and effectiveness data comparing FUM and S1P treatment in Black PwMS are limited. OBJECTIVES: To compare the effectiveness of FUM vs S1P treatment in Black PwMS in the United States. METHODS: This retrospective, observational analysis of the Komodo Health claims database included patients in the US who self-reported their race as Black or African American, were aged 18 to 64 years at index date, and had an MS diagnosis (≥ 1 MS claim [International Statistical Classification of Diseases, Tenth Revision codes]) between January 1, 2016, and April 15, 2023. Patients were followed from first FUM or S1P exposure until end of the study, end of insurance eligibility, gap in index DMT greater than 45 days, or DMT switch. Outcomes included annualized relapse rate (ARR) and time to first relapse. FUM and S1P patient groups were propensity score (PS) matched 2:1 according to baseline characteristics. Outcomes were also compared using inverse probability weighting, and these analyses will be reported in the final presentation. RESULTS: The study included 1664 Black PwMS (FUM, n = 1231; S1P, n = 433). After 2:1 PS matching, 1299 patients were included (FUM, n = 866; S1P, n = 433). Mean (SD) age at baseline was 40.7 (10.9) years in the FUM group and 40.3 (11.4) years in the S1P group. At baseline, mean (SD) MS Severity Score was 6.8 (3.9) for the FUM group and 6.8 (4.1) for the S1P group and mean (SD) ARR was 0.32 (0.73) and 0.35 (0.84), respectively. Mean (SD) postindex duration on FUM and S1P treatment was 441 (392) and 506 (423) days, respectively. Postindex ARR was 0.251 (95% CI, 0.205-0.307) for the FUM group and 0.212 (95% CI, 0.150-0.300) for the S1P group. There was no statistically significant difference in postindex ARRs between FUM and S1P groups (rate ratio, 1.18; P = .655). Adjusted Kaplan-Meier estimated proportions of patients who were relapse free at 2 years were not significantly different between FUM and S1P groups: 72.6% (95% CI, 68.3%-77.1%) and 74.7% (95% CI, 68.9%-80.9%) of patients were relapse free (P = .15), respectively. CONCLUSIONS: In this PS-matched analysis of 1299 Black PwMS, the effectiveness of FUM and S1P was comparable, with no significant differences in relapse outcomes. This is the first comparative effectiveness analysis of these oral DMTs in Black PwMS; the findings are consistent with findings from prior studies demonstrating comparable effectiveness of FUM and S1P in populations of primarily White PwMS. [ABSTRACT FROM AUTHOR] |
