Abstract

BackgroundAdherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS). Patients with lower adherence rates experience more inpatient visits and higher MS-related medical costs. Fingolimod, the first oral DMT approved by the US Food and Drug Administration, may improve the access and compliance to MS treatment when compared to injectable DMTs.MethodsThis retrospective cohort study used pharmacy claims from Medco Health Solutions, Inc., of patients who initiated DMTs between October 2010 and February 2011. Initiation was defined as no prescription fills for the same DMT in the prior 12 months. Patients without a DMT prescription fill 12 months before the index date were considered naïve users. Compliance was measured via proportion of days covered (PDC) and medication possession ratio (MPR) for 12 months post-index. Discontinuation was defined as a ≥60-day gap of index DMT supply. Cox proportional hazard models compared time to discontinuation between cohorts.ResultsOf 1,891 MS patients (mean age: 45.7; female: 76.4%), 13.1% initiated fingolimod, 10.7% interferon beta-1b, 20.0% intramuscular interferon beta-1a, 18.8% subcutaneous interferon beta-1a, and 37.4% glatiramer acetate. Patients initiating fingolimod had highest average PDC and MPR in both experienced (fingolimod: mean PDC=0.83, 73.7% with PDC≥0.8; mean MPR=0.92, 90.5% with MPR≥0.8) and naïve DMT users (fingolimod: mean PDC=0.80, 66.7% with PDC≥0.8; mean MPR=0.90, 87.4% with MPR≥0.8). The proportion of patients discontinuing index DMT within 12 months was significantly lower for the fingolimod cohort (naïve: 31.3%; experienced: 25.7%). Adjusted results found that patients receiving self-injected DMTs discontinued significantly sooner than fingolimod users. This association was generally stronger in experienced DMT users.ConclusionsFingolimod initiators were more compliant, less likely to discontinue treatment, and discontinued later than patients who initiated self-injected DMT.

Highlights

  • Adherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS)

  • (FDA) approved disease-modifying therapies (DMTs), which are efficacious in reducing the frequency of relapses and/or delaying disability progression [4]

  • Fingolimod is the first oral DMT approved by the US Food and Drug Administration

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Summary

Introduction

Adherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS). Fingolimod, the first oral DMT approved by the US Food and Drug Administration, may improve the access and compliance to MS treatment when compared to injectable DMTs. Multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system, is the most common disabling neurological condition in young people, affecting more than 400,000 individuals in the U.S [1,2]. There are multiple Food and Drug Administration (FDA) approved disease-modifying therapies (DMTs), which are efficacious in reducing the frequency of relapses and/or delaying disability progression [4]. Common reasons for discontinuation included flu like symptoms and injection site reactions [6]. Needle phobia is another common tolerability issue of injectable medications that may affect treatment continuation. Patients may not readily perceive the benefits of such costly, inconvenient, and at times painful treatments since DMTs are prescribed to prevent relatively uncommon but disruptive relapse events and disability progression, which occurs over years

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