IQWiG Reports – Commission No. A20-59 Ozanimod (multiple sclerosis) – Benefit assessment according to §35a Social Code Book V1 Extract 1 Translation of Sections 2.1 to 2.5 of the dossier assessment Ozanimod (multiple Sklerose) – Nutzenbewertung gemäß § 35a SGB V (Version 1.0; Status: 13 October 2020). Please note: This translation is provided as a service by IQWiG to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. Extract of dossier assessment A20-59 Version 1.0 Ozanimod (multiple sclerosis) 13 October 2020 Publishing details Publisher Institute for Quality and Efficiency in Health Care Topic Ozanimod (multiple sclerosis) – Benefit assessment according to §35a Social Code Book V Commissioning agency Federal Joint Committee Commission awarded on 15 July 2020 Internal Commission No. A20-59 Address of publisher Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen Im Mediapark 8 50670 Köln Germany Phone: +49 221 35685-0 Fax: +49 221 35685-1 E-mail: [email protected] Internet: www.iqwig.de Institute for Quality and Efficiency in Health Care (IQWiG) - i - Extract of dossier assessment A20-59 Version 1.0 Ozanimod (multiple sclerosis) 13 October 2020 Medical and scientific advice . Jürgen Koehler, Bornheim, Germany IQWiG thanks the medical and scientific advisor for his contribution to the dossier assessment. However, the advisor was not involved in the actual preparation of the dossier assessment. The responsibility for the contents of the dossier assessment lies solely with IQWiG. IQWiG employees involved in the dossier assessment . Bernhard Liebenhoff . Gertrud Egger . Reza Fathollah-Nejad . Klaus Gossens . Ulrike Lampert . Matthias Maiworm . Dominik Schierbaum . Volker Vervölgyi Keywords: Ozanimod, Multiple Sclerosis – Relapsing-Remitting, Benefit Assessment, NCT02047734, NCT02294058 Institute for Quality and Efficiency in Health Care (IQWiG) - ii - Extract of dossier assessment A20-59 Version 1.0 Ozanimod (multiple sclerosis) 13 October 2020 Table of contents Page List of tables ............................................................................................................................. iv List of abbreviations ................................................................................................................ vi 2 Benefit assessment ............................................................................................................. 1 2.1 Executive summary of the benefit assessment .......................................................... 1 2.2 Research question ....................................................................................................... 9 2.3 Research question 1: treatment-naive patients as well as pretreated patients with non-highly active RRMS .................................................................................. 10 2.3.1 Information retrieval and study pool .................................................................... 10 2.3.1.1 Studies included ............................................................................................. 11 2.3.1.2 Study characteristics ...................................................................................... 11 2.3.2 Results on added benefit ....................................................................................... 19 2.3.2.1 Outcomes included ........................................................................................ 19 2.3.2.2 Risk of bias .................................................................................................... 22 2.3.2.3 Results ............................................................................................................ 23 2.3.2.4 Subgroups and other effect modifiers ............................................................ 33 2.3.3 Probability and extent of added benefit ................................................................ 34 2.3.3.1 Assessment of the added benefit at outcome level ........................................ 34 2.3.3.2 Overall conclusion on added benefit ............................................................. 36 2.4 Research question 2: pretreated patients with highly active RRMS.................... 37 2.4.1 Information retrieval and study pool .................................................................... 37 2.4.1.1 Studies included ............................................................................................. 37 2.4.1.2 Study characteristics ...................................................................................... 37 2.4.2 Results on added benefit ....................................................................................... 41 2.4.2.1 Outcomes included ........................................................................................ 41 2.4.2.2 Risk of bias .................................................................................................... 41 2.4.2.3 Results ............................................................................................................ 42 2.4.2.4 Subgroups and other effect modifiers ............................................................ 53 2.4.3 Probability and extent of added benefit ................................................................ 55 2.4.3.1 Assessment of the added benefit at outcome level ........................................ 55 2.4.3.2 Overall conclusion on added benefit ............................................................. 57 2.5 Probability and extent of added benefit – summary .............................................. 58 References for English extract .............................................................................................. 60 Institute for Quality and Efficiency in Health Care (IQWiG) - iii - Extract of dossier assessment A20-59 Version 1.0 Ozanimod (multiple sclerosis) 13 October 2020 List of tables2 Page Table 2: Research questions of the benefit assessment of ozanimod ......................................... 1 Table 3: Ozanimod – probability and extent of added benefit ................................................... 9 Table 4: Research questions of the benefit assessment of ozanimod ....................................... 10 Table 5: Study pool – RCT, direct comparison: ozanimod vs. IFN-β1a .................................. 11 Table 6: Characteristics of the studies included – RCT, direct comparison: ozanimod vs. IFN-β1a .............................................................................................................................. 12 Table 7: Characteristics of the intervention – RCT, direct comparison: ozanimod vs. IFN- β1a ..................................................................................................................................... 14 Table 8: Characteristics of the relevant subpopulation – RCT, direct comparison: ozanimod vs. IFN-β1a (treatment-naive patients and pretreated patients with non- highly active RRMS) ......................................................................................................... 17 Table 9: Risk of bias across outcomes (study level) – RCT, direct comparison: ozanimod vs. IFN-β1a ........................................................................................................................ 19 Table 10: Matrix of outcomes – RCT, direct comparison: ozanimod vs. IFN-β1a (treatment-naive patients and pretreated patients with non-highly active RRMS)............ 21 Table 11: Risk of bias across outcomes and outcome-specific risk of bias – RCT, direct comparison: ozanimod vs. IFN-β1a (treatment-naive patients and pretreated patients with non-highly active RRMS) .......................................................................................... 23 Table 12: Results (mortality, side effects) – RCT, direct comparison: ozanimod vs. IFN- β1a (treatment-naive patients and pretreated patients with non-highly active RRMS), time point 12 months ......................................................................................................... 24 Table 13: Results (morbidity, confirmed relapses) – RCT, direct comparison: ozanimod vs. IFN-β1a (treatment-naive patients and pretreated patients with non-highly active RRMS) ............................................................................................................................... 25 Table 14: Results (morbidity, time to event) – RCT, direct comparison: ozanimod vs. IFN-β1a (treatment-naive patients and pretreated patients with non-highly active RRMS) ............................................................................................................................... 26 Table 15: Results (morbidity, health-related quality of life, continuous) – RCT, direct comparison: ozanimod vs. IFN-β1a (treatment-naive patients and pretreated patients with non-highly active RRMS) .......................................................................................... 27 Table 16: Extent of added benefit at outcome level: ozanimod vs. IFN-β1a (treatment- naive patients and pretreated patients with non-highly active RRMS) ............................. 35 Table 17: Positive and negative effects from the assessment of ozanimod in comparison with IFN-β1a (treatment-naive patients and pretreated patients with non-highly active RRMS) ............................................................................................................................... 36 Table 18: Characteristics of the