title: Comparative Effectiveness Research of Disease-Modifying Therapies for the Management of Multiple Sclerosis: Analysis of a Large Health Insurance Claims Database.
abstract: BACKGROUND
  Limited data are available on the real-world effectiveness of newer oral disease-modifying therapies (DMTs) in multiple sclerosis. The purpose of this study was to retrospectively compare the real-world effectiveness of dimethyl fumarate (DMF), fingolimod, teriflunomide, and injectable DMTs in routine clinical practice based on US claims data.
  
  
  METHODS
  Patients newly-initiating DMF, interferon beta (IFNβ), glatiramer acetate (GA), teriflunomide, or fingolimod in 2013 were identified in the Truven MarketScan Commercial Claims Databases (N = 6372). Relapse episodes were identified based on a published claim-based algorithm and used to determine the annualized relapse rate (ARR) for the year before and after initiating therapy. Poisson and negative binomial regression was used to determine the adjusted incidence rate ratio (IRR) for each therapy relative to DMF.
  
  
  RESULTS
  Significant ARR reductions in the year after initiating therapy were reported for DMF and fingolimod (P < 0.0001). Compared with DMF, the adjusted IRR (95% CI) for relapse in the year after initiating therapy was 1.27 (1.10-1.46) for IFNβ, 1.34 (1.17-1.53) for GA, 1.23 (1.05-1.45) for teriflunomide, and 1.03 (0.88-1.21) for fingolimod. Results were consistent across subgroup and sensitivity analyses.
  
  
  CONCLUSIONS
  These real-world data suggest DMF and fingolimod have similar effectiveness and demonstrate superior effectiveness to IFNβ, GA, and teriflunomide.
  
  
  BACKGROUND
  Biogen, Cambridge, MA, USA.
authors.affiliation: OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, OH, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Boster
authors.affiliation: OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, OH, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nicholas
authors.affiliation: Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Wu
authors.affiliation: Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
authors.forename: Wei-Shi
authors.initials: WS
authors.lastname: Yeh
authors.affiliation: Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Fay
authors.affiliation: Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Edwards
authors.affiliation: Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Huang
authors.affiliation: Biogen, 225 Binney Street, Cambridge, MA, 02142, USA. andrew.lee@biogen.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lee
keywords: Comparative effectiveness; Dimethyl fumarate; Disease-modifying therapy; Fingolimod; Glatiramer acetate; Interferon beta; Multiple sclerosis; Teriflunomide