Clinical characteristics and treatment outcomes in multiple sclerosis patients treated with anti-CD20s who switched to fumarates: a retrospective analysis of a US healthcare claims database
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Anti-CD20 monoclonal antibodies and fumarates are common multiple sclerosis (MS) disease-modifying therapies (DMTs). Data on switching from anti-CD20s to other DMTs are limited. This retrospective, observational study of the US Komodo Health Sentinel claims database aimed to evaluate a de-escalation strategy in a real-world cohort, comparing clinical characteristics, relapses, healthcare encounters (HCEs) and healthcare costs (HCCs) between patients aged ≥18 years with stable MS who switched from anti-CD20s to fumarates (‘Switchers’) versus patients who stayed on anti-CD20s (‘Stayers’). Materials & methods: Patients with MS (diagnosed 1 January 2015–31 August 2022) were propensity score matched 5:1 (Stayers:Switchers) and followed from index to end of study; end of insurance eligibility; >45-day gap in index DMT; or DMT switch. Primary outcomes were clinical characteristics and claims-based annualized relapse rate (ARR). Rates of HCEs and HCCs were estimated. Results: Baseline characteristics were well balanced between cohorts (Stayers, n = 540; Switchers, n = 108). Mean (SD) duration of post-index follow-up was 341.4 (250.0) days for both cohorts. Mean (SD) ARR was 0.08 (0.41; Stayers) versus 0.14 (0.5; Switchers; p = 0.3). Twenty-one Stayers (3.9%) and 1 Switcher (0.9%) were hospitalized for infections, with mean stays of 9.9 and 1 day, respectively. Mean annualized all-cause HCEs were similar between cohorts; annualized inpatient infection-related HCEs were higher for Stayers versus Switchers (mean difference: -0.05; p = 0.005). Annualized all-cause HCCs were similar between cohorts; Switchers had lower annualized infection-related HCCs overall (mean difference: -$2412; p = 0.002) and in the inpatient setting (mean difference: -$2325; p = 0.002). Conclusion: After 1 year, no significant differences in ARR emerged between cohorts. Switchers experienced lower inpatient infection-related HCEs, shorter inpatient infection-related hospital stays and lower overall infection-related HCCs.
Plain language summary – a study looking at people living with multiple sclerosis who switched from treatment with anti-CD20s to fumarates
What is this article about?
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There are many medications available to treat multiple sclerosis (MS) but each differs in how they work, how well they work and associated risks.
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Common medications to treat MS include anti-CD20 monoclonal antibodies and fumarates.
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The aim of this study was to understand the differences in relapses, healthcare visits and healthcare costs in people with stable MS who switched from anti-CD20 to fumarates compared with a matched group of people who stayed on anti-CD20.
What were the results?
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The people in both groups (those who stayed on treatment and those who switched treatment) had similar age, race, insurance type, disease severity and length of time taking anti-CD20 medication. No significant differences in relapse rate were observed between the two groups. Overall healthcare claims and healthcare costs were similar between both groups.
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Patients who switched treatment had lower healthcare claims and healthcare costs related to infections. Costs and healthcare claims related to infections were similar in the emergency room and outpatient setting.
What do the results mean?
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After 1 year, people living with MS who switched treatments from anti-CD20 to fumarates had similar treatment efficacy compared with people who stayed on anti-CD20, but they had fewer infections requiring visits to a healthcare provider or hospital.
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Received: 30 April 2024
Accepted: 13 January 2025
Published online: 12 February 2025
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Clinical characteristics and treatment outcomes in multiple sclerosis patients treated with anti-CD20s who switched to fumarates: a retrospective analysis of a US healthcare claims database. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0071
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