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A Spanish retrospective observational study compared the effectiveness and persistence of first line, moderately effective disease-modifying therapies (DMT) for MS: injectable drugs, dimethyl furamate, and teriflunomide. No difference in effectiveness was observed. However, injectable drugs were associated with a higher discontinuation rate and lower persistence.

No head-to-head trials have been conducted comparing the efficacy and persistence of injectable drugs, dimethyl furamate and teriflunomide were approved for the first line of treatment for MS. Clara López-Caneda, MD, from the Hospital Alvaro Cunqueiro, in Spain, and colleagues conducted a retrospective observational study to evaluate the relative effectiveness and persistence in a real-world setting.

Between early 2015 and early 2024, the researchers included 400 patients who started a first line MS treatment where132 patients with MS were prescribed injectable drugs, 130 dimethyl furamate, and 138 teriflunomide. Clinical and radiological variables were compared. Efficacy was evaluated in terms of percentages of patients reaching NEDA-2 (i.e. absence of relapses and progression of disability) and NEDA-3 (i.e. NEDA-2 plus absence of new T2 lesions or Gd-enhancing lesions on brain MRI). Dropout was defined as DMT discontinuation for any reason for at least 6 months.

During the first year of treatment, 79.8% of participants had NEDA-2 and 59.9% NEDA-3. Teriflunomide was associated with the most favorable outcome, with 87.0% of users reaching NEDA-2, compared with 77.6% on injectable drugs and 73.8% on dimethyl furamate (P<0.05). The survival analysis yielded no differences between the treatments in reaching NEDA-2 (P=0.27) and NEDA-3 (P=0.95). Participants in injectable drugs had a higher dropout rate (62.12%), compared with dimethyl furamate (43.08%) and teriflunomide (40.58%) (P<0.001). Treatment persistence was higher with dimethyl furamate and lower with injectable drugs (P=0.01).

Medical writing support was provided by Michiel Tent

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