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Effects of delayed-release dimethyl fumarate (DMF) on health-related quality of life in patients with relapsing-remitting multiple sclerosis: an integrated analysis of the phase 3 DEFINE and CONFIRM studies.
Clin Ther. 2014 12 01; 36(12):1958-1971.CT

Abstract

PURPOSE

Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) has been reported to have clinical and neuroradiologic efficacy in people with relapsing-remitting multiple sclerosis (RRMS) in the Phase 3 DEFINE and CONFIRM studies. An integrated analysis of data from DEFINE and CONFIRM was conducted to estimate more precisely the therapeutic effects of delayed-release DMF. Here we describe the impact of RRMS on health-related quality of life (HRQoL) at baseline and assess the effects of delayed-release DMF on prespecified HRQoL end points over 2 years.

METHODS

Patients with RRMS were randomly assigned to receive delayed-release DMF 240 mg PO BID or TID or matching placebo for up to 2 years (96 weeks). As a tertiary end point in both studies, patient-reported HRQoL was assessed using the Physical and Mental Component Summaries (PCS and MCS, respectively) of the 36-item Short Form Health Survey (SF-36); global assessment of well-being, as measured on a visual analog scale (VAS); and the EuroQoL-5D (EQ-5D) VAS, administered at baseline and at weeks 24, 48, and 96. Higher scores suggested better HRQoL.

FINDINGS

The integrated analysis included 2301 patients treated with delayed-release DMF BID (n = 769) or TID (n = 761) or placebo (n = 771). The mean PCS and MCS scores at baseline were lower overall compared with those reported in the general US population and were ≥5 points lower (a clinically meaningful difference) in patients with a baseline Expanded Disability Status Scale (EDSS) score of ≥2.5 compared with those in patients with a baseline EDSS score of 0. At 2 years, mean PCS and MCS scores were increased from baseline in the patients treated with delayed-release DMF, whereas the mean PCS and MCS scores were decreased from baseline in the placebo group; the difference in PCS and MCS scores was significant for the delayed-release DMF BID and TID groups compared with placebo. SF-36 subscale scores generally remained stable or were improved relative to baseline in patients treated with delayed-release DMF and decreased in patients receiving placebo; improvements were significant for delayed-release DMF BID and TID versus placebo on most subscales. Compared with that in the placebo group, the proportions of patients in the delayed-release DMF groups exhibiting a ≥5-point improvement in SF-36 score were significantly higher. The following factors were found to be predictive of improved PCS and MCS scores at 2 years: delayed-release DMF treatment, lower baseline EDSS score, age ≤40 years (PCS only), and corresponding lower baseline PCS or MCS score. Changes from baseline in VAS and EuroQoL-5D scores were generally consistent with changes in SF-36 scores.

IMPLICATIONS

These HRQoL benefits parallel the improvements in clinical and magnetic resonance imaging end points with delayed-release DMF, suggesting that delayed-release DMF treatment improves patient-perceived health status as well as neurologic and physical functioning. ClinicalTrials.gov identifiers: NCT0042012; NCT00451451.

Authors+Show Affiliations

Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington. Electronic address: mariko.kita@virginiamason.org.Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, Ohio.Department of Neurology, Saint Josef-Hospital/Ruhr-University Bochum, Bochum, Germany.Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.Multiple Sclerosis Program, Baylor Institute for Immunology Research, Dallas, Texas.Biogen Idec Inc, Cambridge, Massachusetts.Biogen Idec Inc, Cambridge, Massachusetts.Biogen Idec Inc, Cambridge, Massachusetts.Biogen Idec Inc, Cambridge, Massachusetts.Biogen Idec Inc, Cambridge, Massachusetts.Departments of Neurology and Biomedicine, University Hospital Basel, Basel, Switzerland.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

25315404

Citation

Kita, Mariko, et al. "Effects of Delayed-release Dimethyl Fumarate (DMF) On Health-related Quality of Life in Patients With Relapsing-remitting Multiple Sclerosis: an Integrated Analysis of the Phase 3 DEFINE and CONFIRM Studies." Clinical Therapeutics, vol. 36, no. 12, 2014, pp. 1958-1971.
Kita M, Fox RJ, Gold R, et al. Effects of delayed-release dimethyl fumarate (DMF) on health-related quality of life in patients with relapsing-remitting multiple sclerosis: an integrated analysis of the phase 3 DEFINE and CONFIRM studies. Clin Ther. 2014;36(12):1958-1971.
Kita, M., Fox, R. J., Gold, R., Giovannoni, G., Phillips, J. T., Sarda, S. P., Kong, J., Viglietta, V., Sheikh, S. I., Okwuokenye, M., & Kappos, L. (2014). Effects of delayed-release dimethyl fumarate (DMF) on health-related quality of life in patients with relapsing-remitting multiple sclerosis: an integrated analysis of the phase 3 DEFINE and CONFIRM studies. Clinical Therapeutics, 36(12), 1958-1971. https://doi.org/10.1016/j.clinthera.2014.08.013
Kita M, et al. Effects of Delayed-release Dimethyl Fumarate (DMF) On Health-related Quality of Life in Patients With Relapsing-remitting Multiple Sclerosis: an Integrated Analysis of the Phase 3 DEFINE and CONFIRM Studies. Clin Ther. 2014 12 1;36(12):1958-1971. PubMed PMID: 25315404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of delayed-release dimethyl fumarate (DMF) on health-related quality of life in patients with relapsing-remitting multiple sclerosis: an integrated analysis of the phase 3 DEFINE and CONFIRM studies. AU - Kita,Mariko, AU - Fox,Robert J, AU - Gold,Ralf, AU - Giovannoni,Gavin, AU - Phillips,J Theodore, AU - Sarda,Sujata P, AU - Kong,Jessica, AU - Viglietta,Vissia, AU - Sheikh,Sarah I, AU - Okwuokenye,Macaulay, AU - Kappos,Ludwig, Y1 - 2014/10/12/ PY - 2014/03/24/received PY - 2014/07/17/revised PY - 2014/08/21/accepted PY - 2014/10/16/entrez PY - 2014/10/16/pubmed PY - 2016/3/24/medline KW - delayed-release dimethyl fumarate KW - multiple sclerosis KW - quality of life KW - randomized controlled trial SP - 1958 EP - 1971 JF - Clinical therapeutics JO - Clin Ther VL - 36 IS - 12 N2 - PURPOSE: Delayed-release dimethyl fumarate (DMF; also known as gastro-resistant DMF) has been reported to have clinical and neuroradiologic efficacy in people with relapsing-remitting multiple sclerosis (RRMS) in the Phase 3 DEFINE and CONFIRM studies. An integrated analysis of data from DEFINE and CONFIRM was conducted to estimate more precisely the therapeutic effects of delayed-release DMF. Here we describe the impact of RRMS on health-related quality of life (HRQoL) at baseline and assess the effects of delayed-release DMF on prespecified HRQoL end points over 2 years. METHODS: Patients with RRMS were randomly assigned to receive delayed-release DMF 240 mg PO BID or TID or matching placebo for up to 2 years (96 weeks). As a tertiary end point in both studies, patient-reported HRQoL was assessed using the Physical and Mental Component Summaries (PCS and MCS, respectively) of the 36-item Short Form Health Survey (SF-36); global assessment of well-being, as measured on a visual analog scale (VAS); and the EuroQoL-5D (EQ-5D) VAS, administered at baseline and at weeks 24, 48, and 96. Higher scores suggested better HRQoL. FINDINGS: The integrated analysis included 2301 patients treated with delayed-release DMF BID (n = 769) or TID (n = 761) or placebo (n = 771). The mean PCS and MCS scores at baseline were lower overall compared with those reported in the general US population and were ≥5 points lower (a clinically meaningful difference) in patients with a baseline Expanded Disability Status Scale (EDSS) score of ≥2.5 compared with those in patients with a baseline EDSS score of 0. At 2 years, mean PCS and MCS scores were increased from baseline in the patients treated with delayed-release DMF, whereas the mean PCS and MCS scores were decreased from baseline in the placebo group; the difference in PCS and MCS scores was significant for the delayed-release DMF BID and TID groups compared with placebo. SF-36 subscale scores generally remained stable or were improved relative to baseline in patients treated with delayed-release DMF and decreased in patients receiving placebo; improvements were significant for delayed-release DMF BID and TID versus placebo on most subscales. Compared with that in the placebo group, the proportions of patients in the delayed-release DMF groups exhibiting a ≥5-point improvement in SF-36 score were significantly higher. The following factors were found to be predictive of improved PCS and MCS scores at 2 years: delayed-release DMF treatment, lower baseline EDSS score, age ≤40 years (PCS only), and corresponding lower baseline PCS or MCS score. Changes from baseline in VAS and EuroQoL-5D scores were generally consistent with changes in SF-36 scores. IMPLICATIONS: These HRQoL benefits parallel the improvements in clinical and magnetic resonance imaging end points with delayed-release DMF, suggesting that delayed-release DMF treatment improves patient-perceived health status as well as neurologic and physical functioning. ClinicalTrials.gov identifiers: NCT0042012; NCT00451451. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/25315404/Effects_of_delayed_release_dimethyl_fumarate__DMF__on_health_related_quality_of_life_in_patients_with_relapsing_remitting_multiple_sclerosis:_an_integrated_analysis_of_the_phase_3_DEFINE_and_CONFIRM_studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(14)00551-7 DB - PRIME DP - Unbound Medicine ER -