Kesimpta Cost-Effective MS Treatment, Says Canadian Study

Kesimpta (ofatumumab) is more cost effective than nearly all other approved first-line treatments for relapsing-remitting multiple sclerosis (RRMS), according to the results of a recent study conducted in Canada.

Moogeh Baharnoori

Moogeh Baharnoori, M.D., M.Sc., and Canadian colleagues evaluated the cost effectiveness of Kesimpta and other therapies along with best supportive care.

Their results, published in PharmacoEconomics-Open in September, showed that among first-line indicated therapies for RRMS, Kesimpta was dominant (more effective and had lower costs) over Aubagio (teriflunomide), interferons, Tecfidera (dimethyl fumarate), and Ocrevus (ocrelizumab).

“From a Canadian public healthcare system perspective, ofatumumab (Kesimpta) is cost effective against all currently approved and reimbursed disease-modifying therapies (DMTs) for the treatment of relapsing-remitting multiple sclerosis (RRMS), and dominant compared with all disease-modifying therapies with a first-line indication, except glatiramer acetate,” said the "keypoints" call-out in the article.

In contrast to other monoclonal antibodies, which are given intravenously, Kesimpta —  the article used the generic name — is delivered with a subcutaneous injection that can be self-administered at home, allowing greater patient independence, reduced healthcare resource utilization, and access to treatment in areas that aren’t near infusion facilities, she said.

Kesimpta is approved in Canada for initial RRMS therapy but is often reserved for patients with more aggressive disease, Baharnoori noted in the PharmacoEconomics Open article.

Baharnoori is medical director of the Kingston Multiple Sclerosis Clinic and an assistant professor of neurology at the Department of Medicine at Queen’s University in Kingston, Ontario. The study was supported Novartis Pharmaceutical Canada. Novartis makes and markets Kesimpta.

Compared with glatiramer acetate (Copaxone, other brand names) and best supportive care, ofatumumab had incremental cost-effectiveness ratios (ICERs) of $24,189 Canadian dollars per quality-adjusted life-year (QALY) and $28,014/QALY, respectively, according to the Baharnoori and her colleagues.

At a willingness-to-pay threshold of $50,000/QALY, ofatumumab had a 64.3% probability of being cost effective. Among second-line therapies (scenario analysis), ofatumumab dominated natalizumab and fingolimod and resulted in an ICER of $50,969 versus cladribine.

Kesimpta is approved in Canada for initial RRMS therapy but is often reserved for patients with more aggressive disease, Baharnoorinoted in the PharmacoEconomics Open article.

In Canada, five disease-modifying therapies (DMTs) have high efficacy (average relapse reduction > 50%): Gilenya (fingolimod) and cladribine (Mavenclad, others), which are oral medication, and the injectable monoclonal antibodies, including Tysabri (natalizumab), Ocrevus, and Lemtrada (alemtuzumab), according to Baharnoori.

“Evidence suggests that patients have better disease outcomes (i.e., slower disease progression and reduced long-term disability) when higher efficacy treatments are initiated earlier in the disease course,” Baharnoori said. “However, most higher efficacy DMTs associated with increased risk of adverse events , limiting treatment to patients with persistent or high initial disease activity due to a suboptimal response to other DMTs.”