Fumarates and S1Ps Have Comparable Effectiveness in Black Patients with Relapsing Multiple Sclerosis

Fumarates and sphingosine-1-phosphate receptor modulators (S1Ps), 2 types of disease-modifying therapy (DMT), were shown to have comparable effectiveness when used to treat Black patients with relapsing multiple sclerosis (MS). The findings, which were presented at the 24th Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), were consistent with results of previous studies conducted in populations of primarily White people with MS. 

The retrospective, observational analysis used data from the Komodo Health claims database and included people in the United States with MS (diagnosed between 2016 and 2023) who self-reported being Black or African American. A total of 1664 participants were included in the analysis, who were propensity score (PS) matched 2:1 according to baseline characteristics, resulting in 1299 PS score matched participants (fumarate, n=866; S1P, n=433). Outcomes measured included annualized relapse rate (ARR) and time to first relapse, and participants were followed from first S1P/fumarate exposure until end of study, end of insurance eligibility, gap in index DMT, or DMT switch.

In terms of ARR outcomes:

• Baseline mean ARR was 0.32 (standard deviation [SD], 0.73) for those receiving fumarates and 0.35 (SD, 0.84) for those receiving S1Ps.
• Postindex ARR was 0.251 (95% CI, .205 to .307) for the fumarate group and .212 (95% CI, .15 to .3) for the S1P group.
• The difference in postindex ARR between the 2 treatment groups was not statistically significant (rate ratio, 1.18; P=.655).

Additionally, the adjusted Kaplan-Meier estimated proportion of participants who were relapse free at 2 years was not significantly different between the 2 groups (P=.15):

• In the fumarate group, 72.6% (95% CI, 68.3% to 77.1%) were relapse free at 2 years.
• In the S1P group, 74.7% (95% CI, 68.9% to 80.9%) were relapse free at 2 years.

The authors of this study are affiliated with University Hospitals, the Lewis Katz School of Medicine at Temple University, the University of California San Francisco (UCSF) Weill Institute for Neurosciences, UCSF Health, the Icahn School of Medicine at Mount Sinai, Stanford Medicine, the University of Texas Health, San Antonio, the Medical University of South Carolina, and Biogen.