OBJECTIVES: The oral Disease-Modifying Agents (DMA) provided additional options to neurologists beyond injectable DMAs for Multiple Sclerosis (MS). This study examined the factors associated with prescribing teriflunomide (TER) and dimethyl fumarate (DMF) compared to fingolimod (FIN) in patients with MS.

METHODS: A retrospective longitudinal study was conducted involving adults (≥18 years) with MS from the 2015–2019 IBM MarketScan Commercial Claims. Patients with MS were identified based on the ICD-9/10-CM:340/G35 diagnosis and a DMA prescription. Patients were classified as FIN-, TER- and DMF-users based on their first DMA prescription with one year of washout period. Multinomial logistic regression was used to determine the 12-month baseline predisposing, enabling, and need factors associated with prescribing of TER and DMF versus FIN for MS.

RESULTS: The study cohort consisted of 2,556 MS patients; 51.53% initiated with DMF, followed by teriflunomide (24.26%) and fingolimod (24.22%). Multinomial logistic regression revealed that compared to young adults (18-34 years), older adults (≥35 years) had a 2–9 fold higher likelihood to be prescribing with TER and DMF than FIN. Patients from the West had lesser odds of prescribing TER, whereas those from the Northeast had higher odds of prescribing DMF compared to FIN. Patients with HMO insurance had lesser odds of prescribing TER than FIN. Mood disorders were associated with higher odds, and eye disorders had lesser odds of prescribing TER and DMF relative to FIN. Cancer, heart diseases, and nutritional deficiencies had lesser odds, and other neurological disorders had higher odds of prescribing DMF than FIN. Baseline neurologist visit was associated with reduced odds of prescribing TER and DMF compared to FIN.

CONCLUSIONS: The study found that DMF is the most prescribed oral DMA for MS. Patients’ predisposing (age group and region), enabling (insurance), and need factors (comorbidities and neurologist consultation) influenced the selection of specific DMA.