Dimethyl fumarate (DMF), fingolimod, and teriflunomide are oral 
disease-modifying therapies (DMTs) indicated for the treatment of 
relapsing-remitting multiple sclerosis. Despite well-established limitations of 
cross-trial comparisons, DMTs are still frequently compared in terms of relative 
reductions in specific endpoints, most commonly annualized relapse rate. 
Consideration of absolute risk reduction and number needed to treat (NNT) 
provides an alternative approach to assess the magnitude of treatment effect and 
can provide valuable additional information on therapeutic gain. Using data from 
pivotal studies of DMF (DEFINE, NCT00420212; CONFIRM, NCT00451451), fingolimod 
(FREEDOMS, NCT00289978; FREEDOMS II, NCT00355134), and teriflunomide (TEMSO, 
NCT00134563; TOWER, NCT00751881), we calculated NNTs to prevent any relapse, 
more severe relapses (such as those leading to hospitalization or requiring 
intravenous corticosteroids), and disability worsening. Higher relative 
reductions were reported for DMF and fingolimod vs placebo on overall relapse 
and relapses requiring intravenous corticosteroids in both individual and pooled 
studies (pooled data unavailable for fingolimod). However, NNTs for each outcome 
were similar for DMF and teriflunomide, with marginally lower NNTs observed with 
fingolimod. By contrast, for relapses requiring hospitalization, relative 
reductions were higher and NNTs were substantially lower for teriflunomide 
compared with DMF. For fingolimod, there were inconsistent outcomes between the 
two studies for relapses requiring hospitalization; thus, comparative 
conclusions against DMF or teriflunomide cannot be clearly established. The risk 
of disability worsening was significantly reduced in both teriflunomide studies, 
but only in a single study for DMF (DEFINE) and fingolimod (FREEDOMS). NNTs to 
prevent one patient from experiencing disability worsening were similar in 
DEFINE, FREEDOMS, and TEMSO and TOWER but were higher in CONFIRM and FREEDOMS 
II. This NNT analysis demonstrates broadly comparable effects for DMF, 
fingolimod, and teriflunomide across key clinical outcomes. These observations 
are clinically relevant and may help to inform treatment decisions by providing 
additional information on therapeutic gain beyond informal assessments of 
relative reductions alone.