DOI: 10.1177/13524585261475232 ISSN: 1352-4585

Time-dependent divergence in infection risks among patients with multiple sclerosis treated with fumarates versus anti-CD20 monoclonal antibodies

Kyle Smoot, Erin E Longbrake, Mirla Avila, Sarah F Wesley, Afif Hentati, William Meador, John Scagnelli, Lynsey L Lakin, Mark Gudesblatt, Boyang Bian, Jason P Mendoza, Nicholas Belviso, James B Lewin, Sai L Shankar, Ahmed Z Obeidat
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Background:

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.

Objective:

To compare infection incidence, healthcare resource utilization, and relapse outcomes among pwMS receiving fumarate or anti-CD20 therapy for ⩾2 years.

Methods:

This retrospective propensity-matched (1:2) analysis used US Komodo Health claims (1 January 2016–31 May 2022) for pwMS aged 18–64 years with ⩾2 years of continuous follow-up. Outcomes were assessed using Poisson generalized linear models.

Results:

A total of 1956 pwMS were matched (fumarates: n  = 652; anti-CD20s: n  = 1304), with mean follow-up ~3 years. By year 2, the fumarates group had a lower infection rate than anti-CD20s (rate ratio: 0.84; 95% CI: 0.73–0.97; p  = 0.016), 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: 0.52–0.95; p  = 0.021).

Conclusions:

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.

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