NSS. DMF beats GA in real life

Chan A, Cutter G, Fox RJ, Xiao J, Lewin JB, Edwards MR. Comparative effectiveness of delayed-release dimethyl fumarate versus glatiramer acetate in multiple sclerosis patients: results of a matching-adjusted indirect comparison.J Comp Eff Res. 2017. doi: 10.2217/cer-2016-0085. [Epub ahead of print]

Using matching-adjusted indirect comparison (yeah I have no idea what this means either), we compared efficacy outcomes in patients with relapsing-remitting multiple sclerosis treated with delayed-release dimethyl fumarate (DMF) or glatiramer acetate (GA).
MATERIALS & METHODS:An indirect comparison of DMF (patient-level data) and GA (aggregate data) was conducted, with average baseline characteristics of DMF patients weighted to match those for GA patients. Direct comparison of DMF and GA was conducted in CONFIRM. Final results pooled the indirect and direct comparisons using meta-analysis.
RESULTS:After matching, baseline characteristics were balanced between DMF and GA patients. Compared with GA, efficacy was significantly in favor of DMF as measured by annualized relapse rate (rate ratio: 0.76; 95% CI: 0.57-1.00; p = 0.0474) and 12-week confirmed disability progression (risk ratio: 0.59; 95% CI: 0.46-0.76; p < 0.0001).
CONCLUSION:DMF demonstrated superior clinical efficacy versus GA.

GA is currently number one when it comes to sales, but when you look at the efficacy, it is one of the bottom of the pack. This study looks at efficacy of people taking GA and surprise surprise when they compare with DMF, guess which one looks better. 

So if it is worse how come its numero uno on the sales front?.

So one guesses that side-effect profile is perceieved as the important factor and not whether it works or not. 

The alternative view is the laggard lazy neurologist, who figures no monitoring requirements for a while until one finds that it don’t work very well for most people.

I know that some people think it is the best thing since sliced bread:-)

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  • Yes, but don't you know that in general neurologists prefer Copaxone as it is easier to use. There is no monitoring requirements. Out of sight, out of mind.

  • I was on DMF and recently switched to GA because I am planning on having a baby. Teva offered me copay assistance without me asking for one. They didn't even ask for any information on my finances either. I am tempted to stick to GA after the baby is born simply because it is easy on my pocket.

  • "The alternative view is the laggard lazy neurologist, who figures no monitoring requirements for a while until one finds that it don't work very well for most people."

  • Very likely you are right, laggard lazy neurologists are predominant.

    Patients are probably also voting for "no side-effect" ,"no risk". I had a very hard time to convince my daughter to escalate treatment. When you are 22 years old, you want to live your life now, without the side-effects of a drug protecting your future. The future is not guaranteed anyway, a lot can happen outside or in addition to MS.

    Neurologists should educate, explain in addition to treat and it is not easy.

  • Interesting comparison of two drugs of which we have next to no clue as to how they work 😉

    • They both deplete memory B cells, didn't you read our paper:-) DMF is better at doing that than copaxone thats why it is more effective simples.

    • This concept will have difficult because it means they are all the same you could work out efficacy and you could base your choice on side effects

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