The real-world patient experience of fingolimod and dimethyl fumarate for multiple sclerosis.
BACKGROUND
Oral disease-modifying therapies offer equivalent or superior efficacy and greater convenience versus injectable options.


OBJECTIVE
To compare patient-reported experiences of fingolimod and dimethyl fumarate.


METHODS
Adult relapsing-remitting multiple sclerosis patients treated with fingolimod or dimethyl fumarate were recruited from an online patient community and completed an online survey about treatment side effects, discontinuation, and satisfaction.


RESULTS
281 patients in four groups completed the survey: currently receiving fingolimod (CF, N = 61), currently receiving dimethyl fumarate (CDMF, N = 129), discontinued fingolimod (DF, N = 32) and discontinued dimethyl fumarate (DDMF, N = 59). Reasons for treatment switch were to take oral treatment (CF: 63.3 %, CDMF: 61.8 %), side effects of prior medication (CF: 67.3 %, CDMF: 44.1 %) and lack of effectiveness of prior medication (CF: 38.8 %, CDMF: 31.4 %). Main reasons for discontinuation were side effects (DF: 46.9 %, DDMF: 67.8 %) and lack of effectiveness (DF: 25.0 %, DDMF: 15.3 %). CDMF patients had an increased risk of abdominal pain, flushing, diarrhea, and nausea. Treatment satisfaction was highest among CF patients followed by CDMF, DF, and then DDMF patients.


CONCLUSIONS
Discontinuation was driven by experience of side effects. Patients currently taking dimethyl fumarate were more likely to experience a side effect versus patients currently taking fingolimod. Examination of the relationship between tolerability and adherence/persistence is needed.
PatientsLikeMe, 160 Second Street, Cambridge, MA, 02142, USA. pwicks@patientslikeme.com.
Paul
http://orcid.org/0000-0002-2293-9284
P
Wicks
ICON Plc, Medical Affairs Statistical Analysis, Torre Diagonal Mar, Josep Pla, 2, Planta 11, Módulo A1, 08019, Barcelona, Spain.
Lawrence
L
Rasouliyan
PatientsLikeMe, 160 Second Street, Cambridge, MA, 02142, USA.
Bo
B
Katic
ICON Plc, Clinical Outcomes Assessments, 820 W Diamond Ave Ste 100, Gaithersburg, MD, 20878, USA.
Beenish
B
Nafees
ICON Plc, Clinical Outcomes Assessments, 820 W Diamond Ave Ste 100, Gaithersburg, MD, 20878, USA.
Emuella
E
Flood
Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, 07936, USA.
Rahul
R
Sasané
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D000069462:Dimethyl Fumarate / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires
D000069462:Dimethyl Fumarate; D000068876:Fingolimod Hydrochloride
Dimethyl fumarate; Fingolimod; Patient satisfaction; Relapsing-remitting multiple sclerosis; Side effects; Treatment discontinuation