{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:41:58Z","timestamp":1792669318791,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005614","name":"Biogen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005614","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>People with multiple sclerosis (pwMS) treated with anti-CD20 monoclonal antibodies have an elevated infection risk, yet long-term comparative data with oral fumarates are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To compare infection incidence, healthcare resource utilization, and relapse outcomes among pwMS receiving fumarate or anti-CD20 therapy for \u2a7e2\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective propensity-matched (1:2) analysis used US Komodo Health claims (1 January 2016\u201331 May 2022) for pwMS aged 18\u201364\u2009years with \u2a7e2\u2009years of continuous follow-up. Outcomes were assessed using Poisson generalized linear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 1956 pwMS were matched (fumarates:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009652; anti-CD20s:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20091304), with mean follow-up ~3\u2009years. By year 2, the fumarates group had a lower infection rate than anti-CD20s (rate ratio: 0.84; 95% CI: 0.73\u20130.97;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.016), but the most substantial difference was observed in years 4+, where fumarate-treated patients had a 30% reduction versus anti-CD20s (rate ratio: 0.70; 95% CI: 0.52\u20130.95;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.021).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Fumarate therapy was associated with a lower infection risk versus anti-CD20s. The infection rate in the fumarates group remained relatively stable over time, but it progressively increased in the anti-CD20 group, with the most prominent differences observed at year 4 and beyond.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261475232","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T09:00:41Z","timestamp":1787043641000},"page":"1302-1314","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Time-dependent divergence in infection risks among patients with multiple sclerosis treated with fumarates versus anti-CD20 monoclonal antibodies"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8919-4447","authenticated-orcid":false,"given":"Kyle","family":"Smoot","sequence":"first","affiliation":[{"name":"Providence Neurological Specialties, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1179-3937","authenticated-orcid":false,"given":"Erin E","family":"Longbrake","sequence":"additional","affiliation":[{"name":"Yale University, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirla","family":"Avila","sequence":"additional","affiliation":[{"name":"Texas Tech University Health Sciences Center, Lubbock, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9835-2474","authenticated-orcid":false,"given":"Sarah F","family":"Wesley","sequence":"additional","affiliation":[{"name":"Columbia University, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afif","family":"Hentati","sequence":"additional","affiliation":[{"name":"Northshore Endeavor Health, Evanston, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Meador","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Scagnelli","sequence":"additional","affiliation":[{"name":"Raleigh Neurology Associates, Raleigh, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynsey L","family":"Lakin","sequence":"additional","affiliation":[{"name":"West Coast Neurology, Inc., Pomona, CA, USA; University of California, Riverside, Riverside, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7810-4991","authenticated-orcid":false,"given":"Mark","family":"Gudesblatt","sequence":"additional","affiliation":[{"name":"NYU Langone South Shore Neurologic Associates\u2013Patchogue, Patchogue, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0153-4218","authenticated-orcid":false,"given":"Boyang","family":"Bian","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2526-5542","authenticated-orcid":false,"given":"Jason P","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1740-3418","authenticated-orcid":false,"given":"Nicholas","family":"Belviso","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2352-9113","authenticated-orcid":false,"given":"James B","family":"Lewin","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3249-8360","authenticated-orcid":false,"given":"Sai L","family":"Shankar","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3549-3277","authenticated-orcid":false,"given":"Ahmed Z","family":"Obeidat","sequence":"additional","affiliation":[{"name":"Medical College of Wisconsin, Milwaukee, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/cimb45020094"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2020.05.049"},{"key":"e_1_3_5_4_2","unstructured":"MS International Federation. Atlas of MS https:\/\/atlasofms.org\/map\/global\/epidemiology\/number-of-people-with-ms (2025 accessed 9 October 2025)."},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbih.2022.100470"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.3365"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2014-035"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2016.21"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1004795"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1380654"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.4169"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-021-00810-3"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200164"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-025-13133-w"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.104400"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s42466-020-00074-0"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-024-04776-0"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.102988"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-024-00616-7"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-024-02902-0"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2025.106552"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/20552173251371808"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.799138"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12584-x"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.57264\/cer-2024-0071"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585231205708"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520937282"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211037909"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.103921"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211055593"},{"key":"e_1_3_5_31_2","unstructured":"Centers for Disease Control Prevention. ICD-10-CM: International classification of diseases tenth revision clinical modification https:\/\/icd10cmtool.cdc.gov\/ (2025 accessed 12 December 2025)."},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.88.16_supplement.P2.052"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102539"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.102741"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-024-00680-z"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-025-03480-5"}],"container-title":["Multiple Sclerosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585261475232","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13524585261475232","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13524585261475232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:07:10Z","timestamp":1792667230000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13524585261475232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":35,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1177\/13524585261475232"],"URL":"https:\/\/doi.org\/10.1177\/13524585261475232","relation":{},"ISSN":["1352-4585","1477-0970"],"issn-type":[{"value":"1352-4585","type":"print"},{"value":"1477-0970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]}}}