Teriflunomide and Dimethyl Fumarate Result in Similar Clinical Outcomes but Divergent MRI Outcomes in RRMS

Teriflunomide (TRF) and dimethyl fumarate (DMF) offer similar reductions in relapse and disability progression in patients with relapsing-remitting multiple sclerosis (RRMS) after 2 years of treatment, a study in Neurology suggests. Despite similar efficacy profiles, researchers find DMF may be associated with a lower rate of treatment discontinuation and fewer new T2 lesions on magnetic resonance imaging (MRI).

Patients with RRMS treated with either TRF (n=713) or DMF (n=1057) were identified from a French cohort. Only patients who had available brain MRI data at baseline were included in the analysis. Patients treated with TRF were compared with patients treated with DMF, with a specific focus on relapse rate, increase in T2 lesions, increase in the Expanded Disability Status Scale score, and reason for treatment discontinuation. Outcomes at 1 and 2 years after treatment initiation were analyzed.

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At 1 year, there was no difference between the TRF group and the DMF group in regard to the confounder-adjusted proportion of patients who experienced ≥1 relapse (21.6% [95% CI, 18.5%-24.9%] vs 20.2% [95% CI, 17.6%-22.6%], respectively; odds ratio [OR], 0.92 [95% CI, 0.73-1.16]). Results were similar at 2 years for the TRF and DMF groups (30.4% [95% CI, 26.9%-33.9%] vs 29.5% [95% CI, 26.6%-32.2%], respectively]). There was no difference between the TRF group and the DMF group in regard to overall change in the Expanded Disability Status Scale score (27.4% [95% CI, 23.6%-31.4%] vs 27.1% [95% CI, 24.1%-30.4%], respectively; OR, 0.98 [95% CI, 0.77-1.27]).

In the adjusted analysis, a lower proportion of patients treated with DMF had ≥1 new T2 lesion after 2 years of treatment compared with patients treated with TRF (60.8% [95% CI, 56.3%-65.3%] vs 72.2% [95% CI, 66.8%-77.2%], respectively; OR, 0.60 [95% CI, 0.43-.82]; P <.001). A higher proportion of patients in the TRF group discontinued treatment because of lack of effectiveness (14.5% [95% CI, 11.9%-17.3%] vs 8.5% [95% CI, 7.0%-10.2%], respectively; OR, 0.54 [95% CI, 0.41-0.74]; P <.001). Conversely, a greater proportion of patients treated with DMF experienced adverse events after 2 years (21.0% [95% CI, 18.6%-23.6%] vs 16.0% [95% CI, 13.4%-18.8%], respectively; OR, 1.39 [95% CI, 1.09-1.81]; P <.001).

Limitations of the study were the inclusion of patients with missing MRI and disability scores values, as well as potential confounders that were not adjusted for in the final analysis.

According to investigators, the finding that DMF may result in better control of MRI activity than TRF should “be interpreted with caution, as the possible higher effectiveness of DMF must be counterbalanced with the higher rate of treatment withdrawal due to intolerance.”

Disclosure: Several of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Laplaud DA, Casey R, Barbin L, et al. Comparative effectiveness of teriflunomide vs dimethyl fumarate in multiple sclerosis. Neurology. 2019;93(7):e635-e646.