Dimethyl fumarate vs Teriflunomide: an Italian time-to-event data analysis

The introduction of oral disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) changed the therapeutic landscape and algorithms of RRMS treatment (1). In Europe, dimethyl fumarate (DMF) and teriflunomide (TRF) are approved as first-line agents and are often used as the initial therapeutic choice (2, 3). Pivotal trials showed the efficacy of both DMTs on controlling clinical relapses, disability accrual and magnetic resonance imaging (MRI) activity (4-8). Both DMTs had overall good tolerability. There have been no head-to-head randomized trials to compare these two DMTs; however, several real-world evidence (RWE) studies have compared DMF and TRF and provided useful information to guide the selection of either drug for MS patients (9, 10). Although different statistical methods were used, both drugs demonstrated an ability to control disease activity (11-13). In some RWE studies, patients on DMF had a lower relapse rate and a higher relapse-free survival time (11, 12). In this registry-based nationwide cohort Cox-model study, we compared the clinical and radiological activity between patients treated with DMF or TRF.