Evidence mapPaperPMID 41706313Full record

ArticleAdvances in therapy2026

Comparative Effectiveness and Risk of Severe Infection in Adult Patients With MS Treated With Diroximel Fumarate Versus Anti-CD20 Monoclonal Antibodies: A Real-World Claims Analysis.

Ahmed Z Obeidat, Michelle Betz, Rebecca Straus Farber, Erica Goff, Mark Gudesblatt, Le H Hua, Yang Mao-Draayer, Derrick Robertson, Jonathan D Santoro, Tony Wang and 7 more

Abstract readComparative Study
In one paragraph

Article in Advances in therapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Ahmed Z ObeidatMedical College of Wisconsin, Milwaukee, WI, USA.ORCID http://orcid.org/0000-0002-3549-3277
Michelle BetzSentara Medical Group, Virginia Beach, VA, USA.
Rebecca Straus FarberColumbia University Irving Medical Center, New York, NY, USA.
Erica GoffUniversity of Alabama at Birmingham Health System, Birmingham, AL, USA.ORCID http://orcid.org/0000-0003-0250-415X
Mark GudesblattNYU Langone South Shore Neurologic Associates, PC, Patchogue, NY, USA.ORCID http://orcid.org/0000-0002-3700-8554
Le H HuaCleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.ORCID http://orcid.org/0000-0002-0535-3978
Yang Mao-DraayerOklahoma Medical Research Foundation, Oklahoma City, OK, USA.ORCID http://orcid.org/0000-0001-6248-3480
Derrick RobertsonCollege of Medicine, University of South Florida, Tampa, FL, USA.ORCID http://orcid.org/0000-0001-8993-0981
Jonathan D SantoroChildren's Hospital Los Angeles, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0002-8350-8234
Tony WangVoxanalytica/Institute for Health Services Research, San Francisco, CA, USA.
Daniel GomesVoxanalytica/Institute for Health Services Research, San Francisco, CA, USA.ORCID http://orcid.org/0009-0000-5514-9185
Ivan BozinBiogen, Baar, Switzerland.ORCID http://orcid.org/0009-0008-2205-4233
Jason P MendozaBiogen, 225 Binney Street, Cambridge, MA, USA.ORCID http://orcid.org/0000-0003-2526-5542
Boyang BianBiogen, 225 Binney Street, Cambridge, MA, USA.ORCID http://orcid.org/0000-0003-0153-4218
James B LewinBiogen, 225 Binney Street, Cambridge, MA, USA.ORCID http://orcid.org/0000-0002-2352-9113
Nicholas BelvisoBiogen, 225 Binney Street, Cambridge, MA, USA.
Sai L ShankarBiogen, 225 Binney Street, Cambridge, MA, USA. sai.shankar@biogen.com.ORCID http://orcid.org/0000-0003-3249-8360

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionMultiple sclerosis (MS) is a chronic, immune-mediated neurological disease, leading to significant morbidity. Over 25 disease-modifying therapies (DMTs) are approved for MS; however, older patients may benefit less from high-efficacy DMTs. We compared the risk of severe infections (SIs) and annualized relapse rate (ARR) by age (< 45 and ≥ 45 years) between diroximel fumarate (DRF) and anti-CD20 monoclonal antibodies (mAbs) in patients with MS.

methodsThis retrospective study utilized the Komodo Health Claims database to identify patients treated with DRF or anti-CD20 agents. Patients were propensity score matched 1:1 on baseline characteristics and stratified by age (younger: < 45 years; older: ≥ 45 years). Infection-related encounters were identified by diagnosis codes; SIs required hospitalization or intravenous antibiotics. MS relapses were based on inpatient or outpatient claims and associated treatments.

resultsBetween 2016 and 2025, 2894 propensity score-matched patients with MS who initiated DRF (n = 1447) or anti-CD20s (n = 1447) were included. DRF-treated patients had a lower proportion of SIs at 12 and 24 months compared with anti-CD20-treated patients (p ≤ 0.002 at 24 months). Younger DRF-treated patients had significantly fewer SIs (p = 0.005), while older DRF-treated patients had lower non-SI rates. COVID-19-related SIs were also significantly lower in DRF-treated patients (p < 0.001). ARRs were similar between the two groups.

conclusionDRF-treated patients with MS had a significantly lower risk of SI compared with anti-CD20-treated patients, with no difference in ARR. More real-world studies are needed to understand the efficacy and safety of DMTs in the setting of de-escalation in aging patients with MS.

Indexed as

Antibodies, MonoclonalImmunosuppressive AgentsInfectionsMultiple SclerosisAdultAge FactorsAntigens, CD20FemaleFumaratesHumansMaleMiddle AgedPropensity ScoreRetrospective StudiesAntibodies, MonoclonalAntigens, CD20diroximel fumarateFumaratesImmunosuppressive AgentsAgeAnti-CD20 monoclonal antibodyDiroximel fumarateDisease-modifying therapyInfection

Identifiers

PMID41706313
PMCPMC13065559

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.