نبذة مختصرة : Researchers are increasingly using insights derived from large-scale, electronic healthcare data to inform drug development and provide human validation of novel treatment pathways and aid in drug repurposing/repositioning. The objective of this study was to determine whether treatment of patients with multiple sclerosis with dimethyl fumarate, an activator of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway, results in a change in incidence of type 2 diabetes and its complications. This retrospective cohort study used administrative claims data to derive four cohorts of adults with multiple sclerosis initiating dimethyl fumarate, teriflunomide, glatiramer acetate or fingolimod between January 2013 and December 2018. A causal inference frequentist model averaging framework based on machine learning was used to compare the time to first occurrence of a composite endpoint of type 2 diabetes, cardiovascular disease or chronic kidney disease, as well as each individual outcome, across the four treatment cohorts. There was a statistically significantly lower risk of incidence for dimethyl fumarate versus teriflunomide for the composite endpoint (restricted hazard ratio [95% confidence interval] 0.70 [0.55, 0.90]) and type 2 diabetes (0.65 [0.49, 0.98]), myocardial infarction (0.59 [0.35, 0.97]) and chronic kidney disease (0.52 [0.28, 0.86]). No differences for other individual outcomes or for dimethyl fumarate versus the other two cohorts were observed. This study effectively demonstrated the use of an innovative statistical methodology to test a clinical hypothesis using real-world data to perform early target validation for drug discovery. Although there was a trend among patients treated with dimethyl fumarate towards a decreased incidence of type 2 diabetes, cardiovascular disease and chronic kidney disease relative to other disease-modifying therapies-which was statistically significant for the comparison with teriflunomide-this study did not definitively support the hypothesis that Nrf2 activation provided additional metabolic disease benefit in patients with multiple sclerosis.
Competing Interests: This work was funded by Eli Lilly and Company and all authors are employees of Eli Lilly and Company. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Alan J.M. Brnabic was involved with the conceptualization, methodology, investigation and formal analysis of the data for the work and contributed to the original draft preparation, review and editing of the manuscript. Sarah E. Curtis was involved with the conceptualization, methodology, investigation and formal analysis of the data for the work and contributed to the review and editing of the manuscript. Joseph A. Johnston was involved with the conceptualization, methodology and investigation of the data for the work, and contributed to the original draft preparation, review and editing of the manuscript. Albert contributed to the review and editing of the manuscript. Anthony J. Zagar was involved with the methodology and investigation of the data for the work and contributed to the original draft preparation of the manuscript. Ilya Lipkovich was involved with the methodology and validation of the data for the work and contributed to the original draft preparation of the manuscript. Zbigniew Kadziola was involved with the formal analysis of the data for the work and contributed to the review and editing of the manuscript. Megan H. Murray was involved with the investigation, methodology and formal analysis of the data for the work and contributed to the original draft preparation of the manuscript. Timothy Ryan was involved with the conceptualization and investigation of the data for the work and contributed to the original draft preparation, review and editing of the manuscript. All authors have participated sufficiently in the work to agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors give final approval of the manuscript to be published.
(Copyright: © 2024 Brnabic et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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