Comparing Treatment Outcomes for Multiple Sclerosis Using Electronic Health Records Data

A comparative effectiveness study incorporating electronic health records (EHR) data found rituximab had better relapse outcomes versus natalizumab, and similar outcomes between dimethyl fumarate and fingolimod, according to new findings published In JAMA Neurology.

Researchers aimed to address knowledge gaps in treatment guidance for MS by comparing relapse rates of dimethyl fumarate versus fingolimod, and natalizumab versus rituximab therapies using registry data and EHR prescriptions.

Dr Hou et al gathered data from January 2006 through December 2016 from a clinic-based MS research registry and its connected EHR system to compare treatment outcomes for multiple sclerosis.

Four treatment groups were created to compare effectiveness of dimethyl fumarate versus fingolimod and natalizumab versus rituximab, based on registry records and electronic prescriptions. Parallel analyses were conducted between October  2019 and July 2021.

Researchers examined relapse outcomes at 1 year, 2 years, and time to relapse by adjusting for covariates in the registry and EHR, and correcting for confounding biases and multiple testing. 

“As disease-modifying treatment options for multiple sclerosis increase, comparisons of the options based on real-world evidence may guide clinical decision-making,” wrote Jue Hou, PhD, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and co-researchers.

They found no significant differences in relapse rates between dimethyl fumarate and fingolimod. Rituximab had consistently better relapse outcomes versus natalizumab. Natalizumab was associated with higher relapse rates across all 3 outcome measures when compared to rituximab.

“These findings based on high-dimensional modeling that incorporates EHR data address knowledge gaps in MS treatment guidance where randomized clinical trials are unavailable and likely infeasible,” wrote Dr Jeu.

“The study illustrates the value of incorporating electronic health record data as high-dimensional covariates in real-world comparative effectiveness analysis of multiple sclerosis medications,” Dr Jeu et al concluded.

Hou J, Kim N, Cai T, et al. Comparison of Dimethyl Fumarate vs Fingolimod and Rituximab vs Natalizumab for Treatment of Multiple Sclerosis. JAMA Netw Open. 2021;4(11):e2134627. Published 2021 Nov 1. doi:10.1001/jamanetworkopen.2021.34627