Comparative assessment of treatment switching in patients with multiple sclerosis receiving cladribine tablets versus fingolimod, dimethyl fumarate, and teriflunomide.

Comparative data on cladribine tablets (CladT) versus other disease modifying therapies (DMTs) for multiple sclerosis (MS) in the United States (US) are limited. We compared treatment switching and time-to-switch within 1- and 2-year follow-ups between CladT-treated and fingolimod-, dimethyl fumarate-, or teriflunomide-treated patients with MS. Data for this retrospective observational study were sourced from the Komodo Healthcare Map database and included patients aged ≥18 years in the US with ≥2 MS diagnoses ≥30 days apart; ≥1 claim for CladT, fingolimod, dimethyl fumarate, or teriflunomide between 1 April 2019, and 31 December 2020 (initiation date = index); no index DMT in the year prior to the index date (baseline); and continuous enrollment in healthcare insurance from baseline to 2 years after the index date (follow-up). Propensity score weighting with covariate adjusted logistic regression, Kaplan-Meier and Cox regression were employed to assess switching outcomes between groups. Eligible patients (n = 4709) treated with CladT (n = 269), dimethyl fumarate (n = 2314), fingolimod (n = 677), and teriflunomide (n = 1449) were identified from the database. CladT-treated patients were less likely to switch treatment during the 2-year follow-up (10%) compared to fingolimod- (27%), dimethyl fumarate- (44%), or teriflunomide-treated (34%) patients in the weighted cohorts. The adjusted odds ratios (95% confidence interval [CI]) for treatment switching at 2 years were 3.25 (2.03-5.32), 6.75 (4.29-10.92), and 4.65 (2.92-7.59) for fingolimod, dimethyl fumarate, and teriflunomide, respectively, relative to CladT. Cox regression results suggested significant differences in time-to-switch compared to CladT, with hazard ratios of 2.99 (95% CI: 1.89-4.71) for fingolimod, 5.45 (95% CI: 3.73-7.97) for dimethyl fumarate, and 4.06 (95% CI: 2.73-6.06) for teriflunomide. This real-world study revealed significantly lower treatment switching rates in CladT-treated patients than in fingolimod-, dimethyl fumarate- and teriflunomide-treated patients with MS.