Exploring Timing in MS Therapy: Real-World Outcomes of Fumarates

In the ever-evolving treatment landscape for relapsing-remitting multiple sclerosis (RRMS), timely therapeutic choices can shape both clinical and economic trajectories. This retrospective, real-world analysis explored how outcomes differ between patients who initiated treatment with fumarates (FUM) as their first disease-modifying therapy (DMT) versus those who began with teriflunomide (TERI) and later switched to FUM.

Design

Drawing from the Komodo Health claims database (2017–2023), the study included 172 patients who switched from TERI to FUM and 344 propensity-score–matched patients who started FUM as first-line therapy (FUM-1L). Demographic characteristics were balanced: mean age was approximately 46 years, and around 79 percent of each cohort were female.

Results

Among TERI-FUM switchers, annualized relapse rates (ARR) dropped by 29 percent after the switch (rate ratio: 0.71; p = 0.02), demonstrating clear benefit from the transition. However, the FUM-1L group consistently outperformed in relapse prevention across all follow-up periods. Their ARR was 0.18 compared to 0.42 in the TERI-FUM cohort, reflecting a 57 percent lower relapse rate (rate ratio: 0.43; p < 0.0001).

Economic indicators painted a similarly compelling picture. MS-related healthcare resource utilization was 35 percent lower in the FUM-1L group, with a mean full follow-up of 9.28 vs. 14.39 (p = 0.003). Additionally, healthcare costs were nearly halved in the FUM-1L cohort: $14,545 compared to $29,949 in the TERI-FUM group (p < 0.0001). Notably, while TERI-FUM patients saw a post-switch reduction in both relapse rates and HCRU, these metrics never reached the lower baseline levels seen in those treated with FUM from the outset.

Implications

In summary, while switching to FUM post-TERI does offer meaningful improvements, earlier intervention with FUM appears to maximize both clinical control and economic efficiency, reinforcing the importance of strategic treatment planning early in the MS journey.

Reference

Conway DM, A.; Shah, S.; Travis, L.; Akinsanya, J.; Szewczyk, A.; Lewin, J. B.; Belviso, N.; Shankar, S. L. Treatment outcomes in people with multiple sclerosis who switched from teriflunomide to fumarates versus initiating fumarates as a first-line therapy. Poster presented at CMSC; May 28–31, 2025; Phoenix, AZ, USA. DMT06.