Real-world Study Finds Fingolimod Leads to Better Clinical Outcomes but Higher Healthcare Costs in MS Patients

Multiple sclerosis (MS) is a highly variable autoimmune disease requiring individualized treatment with diverse options for disease-modifying therapies (DMTs). Costs, administration methods, safety profiles, and mechanisms of action differ among DMTs. As such, a one-size-fits-all approach to managing MS is not plausible.

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It is estimated that the total economic burden of MS in the U.S. is $85.4 billion, with retail prescription medications accounting for over half of this cost and clinic-administered drugs making up another 12%. In 2010, the FDA approved the first oral DMT for MS, Gilenya (fingolimod), and several others have been approved since. Little is known about how these oral treatments compare in terms of the use of health care resources, costs, and clinical outcomes in a real-world setting.

In a retrospective study published earlier this month in the Journal of Managed Care and Specialty Pharmacy, researchers from Humana in Louisville, KY, compared clinical outcomes, time on treatment, healthcare resources utilization, and relative costs in patients with MS that were newly initiated on one of the following oral DMTs: dimethyl fumarate, fingolimod, or teriflunomide.

The study, led by Patrick Racsa, M.S., used the Humana Research Database to identify 1,442 patients with MS who had initiated one of the three compared drugs between January 1, 2013, and December 31, 2018. A total of 843 patients took dimethyl fumarate, 213 took fingolimod, and 386 were in the teriflunomide group. The patients were followed for at least 12 months (mean 3.8 years) until the end of the study period, health insurance plan disenrollment, or death (whichever occurred first).

Racsa and his colleagues found that time on therapy in mean days differed significantly among the three cohorts and was longest for patients taking fingolimod. A lower percentage of patients discontinued fingolimod compared with the other two DMTs (74.7% for fingolimod, 85.3% for dimethyl fumarate, and 80.7% for teriflunomide). The annualized relapse rate, inpatient hospital stays, and emergency department visits were also lowest in patients taking fingolimod.

When comparing relative healthcare costs using dimethyl fumarate as a reference point, all-cause total costs were 21.1% higher, and all-cause pharmacy costs were 23.1% higher for patients taking fingolimod. There were no differences in all-cause healthcare costs between the dimethyl fumarate and teriflunomide cohorts.

Racsa and his colleagues concluded that initial oral treatment with fingolimod may result in better clinical outcomes and decreased health care resource utilization compared with dimethyl fumarate and teriflunomide in patients with MS. However, oral fingolimod therapy may lead to higher all-cause total and pharmacy costs. They suggest that the higher pharmacy costs may drive the higher costs associated with fingolimod.

“Future studies should consider recently approved DMTs, assess causes of medication discontinuation and switching, consider the relationship between discontinuing DMTs and subsequent [health care resource utilization], and evaluate outcomes in later lines of therapy,” the authors wrote.