Comparative Analysis of Dimethyl Fumarate and Teriflunomide in Relapsing Remitting Multiple Sclerosis.

BACKGROUND: In relapsing-remitting multiple sclerosis, analyses from observational studies comparing dimethyl fumarate and teriflunomide showed conflicting results. We aimed at comparing the effectiveness of dimethyl fumarate and teriflunomide in a real-world setting, where both drugs are licensed as first-line therapies for relapsing remitting multiple sclerosis. METHODS: We included all patients who initiated dimethyl fumarate or teriflunomide between 2013 and 2022, listed in the Swiss National Treatment Registry. Coarsened exact matching was applied using age, gender, disease duration, baseline Expanded Disability Status Scale (EDSS), time since last relapse, and relapse rate in the previous year as matching variables. Time to relapse and time to 12 months confirmed EDSS worsening were compared using Cox-proportional hazard models. RESULTS: In total, 2028 patients were included, of which 1498 were matched (dimethyl fumarate: n=1090, 69.6% female, mean age 45.1, median EDSS 2.0; teriflunomide: n=408, 68.9% female, mean age 45.1, median EDSS 2.0). Time to relapse and time to EDSS worsening was longer in the dimethyl fumarate compared to teriflunomide group (HR 0.734, p=0.026 and HR 0.576, p=0.003, respectively). CONCLUSION: Analysis of real-world data showed that dimethyl fumarate treatment was associated with more favorable outcomes than teriflunomide.