Understanding Treatment Decisions and Differences Between Diroximel Fumarate and Dimethyl Fumarate

Meghan Garabedian, CRNP, MSN

At the 2022 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, June 1-4, in National Harbor, Maryland, a group of investigators aimed to asses patient-reported outcomes and experiences for patients with multiple sclerosis (MS) currently taking diroximal fumarate (DRF; Vumerity; Biogen) and dimethyl fumarate (DMF; Tecfidera; Biogen). A total of 452 patients from the MyMSTeam social network completed an online survey that focused on benefits, tolerability, and mitigation strategies for DRF, as well as awareness, interest, and barriers to considering the disease-modifying therapy (DMT).

In total, 8% of the cohort were receiving DRF, 17% were receiving DMF, 27% had previously received DMF, and 18% were receiving other non-DMF/DRF oral DMTs. The most common reasons for initiating DRF were health care provider’s recommendation (75%), and preference for an oral treatment (44%). Additionally, 69% of patients on DRF reported physical benefits despite an average treatment duration of less than 1 year. Physical benefits for DRF included slowed disease progression (42%), decreased relapses (31%), and prevention of new symptoms (28%).

The results also showed that 32% of those on DMF took interest in DRF when they were informed it would be similar to DMF, but with fewer gastrointestinal issues. Furthermore, the DRF dosing schedule was cited as a reason not to consider DRF in 8% of those on injectable DMTs and 19% of those on other non-fumarate oral DMTs. To learn more about the study and the clinical significance of these findings, NeurologyLive® sat down with lead investigator Meghan Garabedian, CRNP, MSN. Garabedian, a nurse practitioner at the University of Pennsylvania, provided insight on the differences between the drugs, the important take-home points of the analysis, and why treatment optimization must be an individualized approach.

NeurologyLive^®: How did you go about this analysis?

Meghan Garabedian, CRNP, MSN: I partnered with Biogen, who sponsored the poster. It was more about the patient experience on DRF and how patients are tolerating it. This is an area that needs to be addressed in order to understand if a product is working for a patient population or not. At the end of the day, we’re here to take care of the patient, and they’re not going to take a product if they feel like the tolerability is not well. I like the idea that it was done probably in a scenario where they were more honest because there wasn’t a provider right in front of them. They were doing an online survey with close-ended questions. It’s a good way of tracking our patients about how they’re feeling towards a product, and if they’re finding benefits of taking that product.

What are the greatest take-home aspects of the study clinicians should be aware of?

The biggest take-home point is that the patients tolerated the medication when switching to DRF based on their doctor’s or provider’s recommendation, which some of that could have come from insurance and not necessarily paying for it or using copay assistance. Seeing that they are tolerating it, the [adverse] effects are tolerable, and that their quality of life is well on this current treatment.

With the influx of treatment options for patients with MS, is diroximel fumarate one that gets lost in the shuffle? Are clinicians not fully aware of its benefits?

There is a patient for every different medication out there. There is no one-size-fits-all and that’s what’s so nice about this landscape. When I came into the field to now where we are, we have something for every type of patient. That includes the patient that doesn’t want to take medications all the time, the patient that doesn’t want to do injectables, the patient that wants to take a pill, and the patient that doesn’t necessarily want infusion. There’s definitely a patient for this DRF and they tolerate it when they take it. Also, it can be a good platform for patients who are concerned about immune responses to vaccines and being immunocompromised, as well as those who are considering family planning as well.

How can we improve treatment optimization for the future?

The one type of research that needs more work is progression and stopping that progression. We’re good as far as stopping inflammation and relapses, but there needs to be more done as far as remyelination and preventing further progression for these patients.

Are there some groups of patients who may see more benefit from DRF than others?

There’s not a specific trend, but this could be better for a patient that’s fine taking medication orally, fine with getting bloodwork done every once in a while, and those who are concerned about vaccine responses with other medications. Patients have done well on this medication and they’re more comfortable on medications that we have more research on. It was basically a medication that now has less tolerability issues than some of our other medications out there. As far as [gastrointestinal adverse] effects, they’re much improved with this medication compared to its previous DMF. That’s one thing, but it’s helpful for patients that maybe want a short half-life for particular reasons such as family planning and if they want to wait multiple months or not.

It’s a good treatment for patients that don’t want to go to infusible treatments and scared of injections. Patients have shown good responses in patient-reported outcomes, but sometimes we have to look at exactly what they are, patient-reported outcomes. We’ll have to take a look at the clinical research as well, but it’s important to look at the patient’s experience in this.

What has been your general reaction to CMSC 2022?

I haven’t been to the actual conference in about 5 years, so it’s been nice to see how much we’ve expanded as far as different things we’re thinking about. There’s so much more on diet, our tentative therapies and options we can offer our patients, not just the disease-modifying therapies. It’s about trying to treat the patient as a whole and using all the things we can offer. Also, expanding into more patient-related education has been great at the conference. It’s been awesome to see the expansion in all different types of interdisciplinary care to our patient population and how it can benefit them and us as providers.

Transcript edited for clarity. Click here for more coverage of CMSC 2022.

REFERENCE
1. Garabedian M, Roman C, Bruen DR, et al. Patient experience on diroximel fumarate (DRF) from the MyMSTeam Social Network: considerations for DMT selection. Presented at: CMSC Annual Meeting, 2022; June 1-4; National Harbor, MD. DMT44