Abstract Details

Title Long-Term Safety and Effectiveness of Delayed-release Dimethyl Fumarate in Multiple Sclerosis Patients Treated in Routine Medical Practice, an updated analysis of the ESTEEM Study

Topic Multiple Sclerosis

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-009

Background DMF has demonstrated a favorable benefit–risk profile in patients with relapsing forms of MS in clinical trials and real-world studies. To provide information on long-term exposure in clinical practice, the ESTEEM study (NCT02047097) was conducted.

Objective To assess long-term safety and effectiveness of delayed-release dimethyl fumarate (DMF) in patients with relapsing forms of multiple sclerosis (MS) in clinical practice.

Design/Methods In this ongoing study, patients treated with DMF were recruited from ~380 sites. The primary objective was to assess the incidence and type of serious adverse events (SAEs) and AEs leading to discontinuation. Secondary objectives included assessment of DMF effectiveness on annualized relapse rate (ARR) and patient-reported outcomes (PROs).

Results As of April 2021, 5251 patients had received >1 dose of DMF. Mean (SD) age of patients at enrollment was 40.1 (11.2) years; 74.0% were female. Patients received DMF for a mean (SD) duration of 30.4 (20.4) months. Primary reasons for discontinuation were AEs (1066/5251; 20.3%), of which the most common were gastrointestinal AEs (442/1066; 41.5%), and efficacy reasons (439/5251, 8.4%). Of 5251 patients, 173 (3.3%) patients discontinued due to lymphopenia. SAEs were reported in 326 (6.2%) patients, most commonly infections and infestations (n=86; 1.6%). No PML was reported. Adjusted ARR (95% CI) remained low, ranging from 0.16 (0.14–0.17) after Year 1 to 0.05 (0.04–0.08) after Year 5. Mean scores for measures of physical and psychological impact, fatigue, overall health outcomes, and work productivity and activity impairment remained stable at 5.5 years compared with baseline.

Conclusions In this interim analysis, DMF demonstrated a safety profile in real-world clinical practice consistent with the known profile of DMF. Similarly, relapse rates were low and both ARR and PROs remained stable over time. This indicates a sustained effectiveness for patients who remain on DMF treatment for up to 5 years.

Authors/Disclosures
Krupa S. Pandey, MD (Hackensack University Medical Center) PRESENTER	Dr. Pandey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Pandey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi Genzyme. Dr. Pandey has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech . Dr. Pandey has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for BMS. Dr. Pandey has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen . Dr. Pandey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech . Dr. Pandey has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Horizon Therapeutics . The institution of Dr. Pandey has received research support from NIH. The institution of Dr. Pandey has received research support from CMSC.
Kathryn Giles	Kathryn Giles has stock in Synderdisc. The institution of Kathryn Giles has received research support from Biogen.
Konstantin E. Balashov, MD, PhD, FAAN (Department of Neurology, BMC and BUSM)	Dr. Balashov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech.
Richard A. Macdonell, MD, FAAN (Austin Health)	Dr. Macdonell has nothing to disclose.
Jorg Windsheimer	Jorg Windsheimer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck, Biogen,BMS,Janssen,Roche,Hexal. Jorg Windsheimer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen,Teva,BMS.
Mikel Martinez, MD	No disclosure on file
Ivan Bozin (Biogen International GmbH)	Dr. Bozin has received personal compensation for serving as an employee of Biogen. Dr. Bozin has received personal compensation for serving as an employee of Arvelle Therapeutics. Dr. Bozin has stock in Biogen.
Phoebe Jiang, PhD	Dr. Jiang has received personal compensation for serving as an employee of Biogen. Dr. Jiang has stock in Biogen.
	No disclosure on file
	No disclosure on file
Annette Okai, MD, FAAN (North Texas Institute of Neurology and Headache)	Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Okai has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Okai has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi Genzyme. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Okai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD SERONO . Dr. Okai has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi Genzyme .