{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:41:35Z","timestamp":1753882895681,"version":"3.41.2"},"reference-count":39,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"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":["Multiple Sclerosis Journal - Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> The use of non-specific immunosuppressants (NSIS) to treat multiple sclerosis (MS) remains prevalent in certain geographies despite safety concerns, likely due to resource limitations. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p> To use MSBase registry data to compare real-world outcomes in adults with relapsing-remitting MS (RRMS) treated with dimethyl fumarate (DMF) or NSIS (azathioprine, cyclosporine, cyclophosphamide, methotrexate, mitoxantrone or mycophenolate mofetil) between January 1, 2014 and April 1, 2022. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> Treatment outcomes were compared using inverse probability of treatment weighting (IPTW) Cox regression. Outcomes were annualized relapse rates (ARRs), time to discontinuation, time to first relapse (TTFR) and time to 24-week confirmed disability progression (CDP) or 24-week confirmed disability improvement (CDI; in patients with baseline Expanded Disability Status Scale [EDSS] score \u22652). <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> After IPTW, ARR was similar for DMF (0.13) and NSIS (0.16; p\u2009=\u20090.29). There was no difference in TTFR between cohorts (hazard ratio [HR]: 0.98; p\u2009=\u20090.84). The DMF cohort experienced longer times to discontinuation (HR: 0.75; p\u2009=\u20090.001) and CDP (HR: 0.53; p\u2009=\u20090.001), and shorter time to CDI (HR: 1.99; p\u2009&lt;\u20090.008), versus the NSIS cohort. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> This analysis supports the use of DMF to treat patients with relapsing forms of MS, and may have implications for MS practices in countries where NSIS are commonly used to treat RRMS. <\/jats:p><\/jats:sec>","DOI":"10.1177\/20552173241247182","type":"journal-article","created":{"date-parts":[[2024,5,25]],"date-time":"2024-05-25T07:24:25Z","timestamp":1716621865000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of dimethyl fumarate versus non-specific immunosuppressants:  Real-world evidence from MSBase"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9204-3216","authenticated-orcid":false,"given":"Tim","family":"Spelman","sequence":"first","affiliation":[{"name":"MSBase Foundation, Melbourne, Australia"},{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9159-3128","authenticated-orcid":false,"given":"Sara","family":"Eichau","sequence":"additional","affiliation":[{"name":"Hospital Universitario Virgen Macarena, Sevilla, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raed","family":"Alroughani","sequence":"additional","affiliation":[{"name":"Amiri Hospital, Sharq, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serkan","family":"Ozakbas","sequence":"additional","affiliation":[{"name":"Dokuz Eylul University, Konak\/Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia J","family":"Khoury","sequence":"additional","affiliation":[{"name":"American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-0846","authenticated-orcid":false,"given":"Francesco","family":"Patti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Kubala Havrdova","sequence":"additional","affiliation":[{"name":"Department of Neurology, First Medical Faculty, Charles University in Prague and General University Hospital, Prague, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cavit","family":"Boz","sequence":"additional","affiliation":[{"name":"KTU Medical Faculty Farabi Hospital, Trabzon, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Terzi","sequence":"additional","affiliation":[{"name":"19 Mayis University, Samsun, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Kuhle","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital and University of Basel, Basel, Switzerland"},{"name":"Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Grammond","sequence":"additional","affiliation":[{"name":"CISSS Chaudi\u00e8re-Appalache, L\u00e9vis, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanette","family":"Lechner-Scott","sequence":"additional","affiliation":[{"name":"University of Newcastle, Newcastle, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-0116","authenticated-orcid":false,"given":"Orla","family":"Gray","sequence":"additional","affiliation":[{"name":"South Eastern HSC Trust, Belfast, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3325-3760","authenticated-orcid":false,"given":"Maria Pia","family":"Amato","sequence":"additional","affiliation":[{"name":"University of Florence, Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy","family":"Laureys","sequence":"additional","affiliation":[{"name":"University Hospital Ghent, Ghent, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vahid","family":"Shaygannejad","sequence":"additional","affiliation":[{"name":"Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hyde","sequence":"additional","affiliation":[{"name":"Biogen, Baar, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haijue","family":"Wang","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Bozin","sequence":"additional","affiliation":[{"name":"Biogen, Baar, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Belviso","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1040-3930","authenticated-orcid":false,"given":"Chao","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Huashan Hospital, National Center for Neurological Disorders, Fudan University, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Biogen, Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4278-7003","authenticated-orcid":false,"given":"Anneke","family":"van der Walt","sequence":"additional","affiliation":[{"name":"Monash University, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmut","family":"Butzkueven","sequence":"additional","affiliation":[{"name":"The Alfred Hospital, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the MSBase Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,5,25]]},"reference":[{"key":"bibr1-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2004.02.012"},{"key":"bibr2-20552173241247182","unstructured":"Pfizer. Novantrone\u00ae (Mitoxantrone) prescribing information. https:\/\/www.pfizermedicalinformation.com\/en-us\/mitoxantrone\/dosage-admin (accessed July 23, 2023)."},{"key":"bibr3-20552173241247182","unstructured":"Pfizer. Novantrone\u00ae (Mitoxantrone) summary of product characteristics. https:\/\/www.ema.europa.eu\/en\/documents\/referral\/novantrone-article-30-referral-annex-iii_en.pdf (2016, accessed July 21, 2023)."},{"key":"bibr4-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurt.2007.08.003"},{"key":"bibr5-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1038\/s41573-022-00477-5"},{"key":"bibr6-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-018-0564-y"},{"key":"bibr7-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.6.1607"},{"key":"bibr8-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005347"},{"key":"bibr9-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008933.pub2"},{"key":"bibr10-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.26858"},{"key":"bibr11-20552173241247182","unstructured":"Biogen. TECFIDERA\u00ae (dimethyl fumarate) delayed-release capsules, for oral use. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2023\/204063s029lbl.pdf (2023, accessed July 4, 2023)."},{"key":"bibr12-20552173241247182","unstructured":"Biogen Netherlands BV. TECFIDERA\u00ae summary of product characteristics. https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/tecfidera-epar-product-information_en.pdf (2022, accessed July 4, 2023)."},{"key":"bibr13-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1206328"},{"key":"bibr14-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114287"},{"key":"bibr15-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211037909"},{"key":"bibr16-20552173241247182","unstructured":"Biogen. Data on file. 2024."},{"key":"bibr17-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-022-06126-4"},{"key":"bibr18-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1177\/13524585221137502"},{"key":"bibr19-20552173241247182","unstructured":"MSBase Neuro-Immunology Registry. https:\/\/www.msbase.org\/ (accessed February 2023)."},{"key":"bibr20-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1177\/1352458506070775"},{"key":"bibr21-20552173241247182","unstructured":"Genentech. OCREVUS\u00ae (ocrelizumab) prescribing information. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2023\/761053s031lbl.pdf (2023, accessed November 24, 2023)."},{"key":"bibr22-20552173241247182","unstructured":"Genzyme. LEMTRADA\u00ae (alemtuzumab) prescribing information. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2022\/103948s5187lbl.pdf (2023, accessed November 24, 2023)."},{"key":"bibr23-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-020-00847-0"},{"key":"bibr24-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.124958"},{"key":"bibr25-20552173241247182","doi-asserted-by":"publisher","DOI":"10.2174\/1871523014666150504122220"},{"key":"bibr26-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1177\/2055217317725102"},{"key":"bibr27-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15071"},{"key":"bibr28-20552173241247182","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2014-101"},{"key":"bibr29-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-019-0127-2"},{"key":"bibr30-20552173241247182","volume":"9","author":"Tramacere I","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr31-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1177\/1756285610379885"},{"key":"bibr32-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0113371"},{"key":"bibr33-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.148"},{"key":"bibr34-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-016-0042-8"},{"key":"bibr35-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-020-00192-6"},{"key":"bibr36-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-020-00193-5"},{"key":"bibr37-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-017-0080-x"},{"key":"bibr38-20552173241247182","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws375"},{"key":"bibr39-20552173241247182","unstructured":"Ingenus Pharmaceuticals. Cyclophosphamide prescribing information. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2020\/212501s000lbl.pdf (2020, accessed July 21, 2023)."}],"container-title":["Multiple Sclerosis Journal - Experimental, Translational and Clinical"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552173241247182","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552173241247182","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552173241247182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,2]],"date-time":"2025-03-02T16:49:57Z","timestamp":1740934197000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552173241247182"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1177\/20552173241247182"],"URL":"https:\/\/doi.org\/10.1177\/20552173241247182","relation":{},"ISSN":["2055-2173","2055-2173"],"issn-type":[{"type":"print","value":"2055-2173"},{"type":"electronic","value":"2055-2173"}],"subject":[],"published":{"date-parts":[[2024,4]]},"article-number":"20552173241247182"}}