Comparable Efficacy and Safety of Teriflunomide versus Dimethyl Fumarate for the Treatment of Relapsing-Remitting Multiple Sclerosis

Nasim Nehzat; Omid Mirmosayyeb; Mahdi Barzegar; Reza Vosoughi; Erfane Fazeli; Vahid Shaygannejad

doi:10.1155/2021/6679197

Comparable Efficacy and Safety of Teriflunomide versus Dimethyl Fumarate for the Treatment of Relapsing-Remitting Multiple Sclerosis

Neurol Res Int. 2021 Jul 15:2021:6679197. doi: 10.1155/2021/6679197. eCollection 2021.

Authors

Nasim Nehzat^{1

2}, Omid Mirmosayyeb^{1

2

3}, Mahdi Barzegar^{1

3}, Reza Vosoughi⁴, Erfane Fazeli¹, Vahid Shaygannejad^{1

3}

Affiliations

¹ Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
² Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ University of Toronto, St. Michael's Hospital Multiple Sclerosis Clinic, Toronto, Ontario, Canada.

Abstract

Background: The aim of this observational study is to investigate the efficacy and safety of two approved oral disease-modifying therapies (DMTs) in patients with remitting-relapsing multiple sclerosis (RRMS): dimethyl fumarate (DMF) vs. teriflunomide (TRF).

Methods: A total of 159 RRMS patients (82 on TRF and 77 on DMF) were included. The expanded disability status scale (EDSS), confirmed disability improvement (CDI), confirmed disability progression (CDP), and annualized relapse rate (ARR) were evaluated for the two-year period prior to enrollment in our study. The drug-associated adverse effects (AEs) were recorded. We conducted propensity matching score to compare the efficacy between TRF and DMF.

Results: After matching for the confounders, TRF- and DMF-treated groups were not different in terms of EDSS (P value = 0.54), CDI (P value = 0.80), CDP (P value = 0.39), and ARR (P value >0.05). TRF discontinuation occurred in 2 patients (2.43%) due to mediastinitis and liver dysfunction, while a patient (1.29%) discontinued DMF due to depression. Incidence rate of AEs in the TRF-treated group was 81.4%: hair thinning (hair loss) (62.9%), nail loss (20.9%), and elevated aminotransferase (14.8%) were the most common AEs; in DMF-treated patients, AEs were 88.2% with predominance of flushing (73.2%), pruritus (16.9%), and abdominal pain (16.9%).

Conclusion: Based on our findings, DMF is as efficacious and safe as TRF for the treatment of RRMS in our Iranian study population. Multicentric studies need to corroborate these findings in other populations.