A discussion regarding the use of ozanimod compared with teriflunomide as treatment for multiple sclerosis utilizing statistical matching, and the role S1P receptor modulators play in clinical practice.
Robert Naismith, MD: There’s always a great desire to have more head-to-head comparisons. These trials are very expensive and difficult to recruit. One strategy is to do statistical matching. Specifically, propensity-based matching analyses can be done so you can look at existing data. Here, the authors looked at existing clinical trials and matched them on baseline characteristics. They were able to provide some analysis of a comparison between ozanimod and teriflunomide.
From my perspective, the S1Ps, as a class, seem to rate a bit better in regard to efficacy, compared with some of the other oral therapies and injectable therapies. Even though there has not been a direct comparison with ozanimod and teriflunomide, you would suspect there may be some benefit. Like we were talking about with the ponesimod study, that trial did use teriflunomide. There is a precedent that an S1P was effective compared with a DHODH inhibitor.
What they found in this propensity-matched weighted analysis was that the relapses were reduced, I think, by 27%, and disease progression was reduced by about 22%. These are nice data to have. With these propensity-matched analyses, you need to be a bit cautious, because they assume you know all the confounders and differences between the populations measured. It adds to the literature, but we always need to be careful about over-interpreting these data. It’s good to have them in instances where no data exist, but a direct head-to-head study is always preferred.
This is very much in line with our notion of where efficacy fits, in terms of standard or moderate efficacy vs high efficacy. I would say that most MS [multiple sclerosis] clinicians would say that the monoclonal antibodies represent our high-efficacy therapies and that we have a middle efficacy bin, and S1Ps likely fit in that bin. It’s very much in line with how we conceptualize the treatments and how we balance efficacy and safety across these different options.