Efficacy and safety of fingolimod and dimethyl fumarate for management of multiple sclerosis: A single center retrospective study

Objective: To observe the efficacy and safety of fingolimod and dimethyl fumarate (DMF) in patients with relapsing multiple sclerosis (RMS).Background: Fingolimod was the very first oral disease modifying therapy (oDMT) approved by FDA in 2010 for treatment of RMS. It has changed the therapeutic paradigm of the disease. ODMT are now commonly used as a first line of treatment.Design/Methods: Retrospective chart review of patient’s with multiple sclerosis (MS), treated with fingolimod and DMF was performed. Patients demographics, duration of disease, type of MS, side effects of medications, clinical and radiographic data were recorded. We performed a survival analysis using Kaplan-Meier methods and cox proportional hazards modeling and report hazard ratio of relapse and MRI lesions.Results: Our study population consisted of 141 patients: 111(79%) on DMT and 30(21%) on Fingolimod. Median(IQR) age was 50(42–56), 76% female, and 59% White. Median(IQR) disease duration was 12(8–19) years and time on oDMT was 2.8 (1.2–3.9) years. The percentage of patients who experienced side-effects was 40%; with flushing common in DMF(23% vs 0%, p<0.01) and bradycardia common in Fingolimod(10% vs 1%, p<0.01). Median(IQR) time to first relapse post-oDMT initiation was 1.2 (0.2–2.9) years with no statistically significant difference between the two groups. Median (IQR) time to new/enhanced brain T2 MRI lesion post-oDMT initiation was shorter for DMF compared to Fingolimod: 0.9(0.2–1.5) vs 1.4(0.7–2.3), respectively(p<0.01).Conclusions: The interesting finding of our study is a shorter median (IQR) time to new or enhanced Brain MRI lesions in DMF group compared to Fingolimod group. The time to first relapse was not significantly different between groups. The limitation of our study is a small sample size and retrospective design. The complete data analysis of over 300 patients will be presented at AAN 2020.