ND3 - META-ANALYSIS OF REAL-WORLD ADHERENCE AND PERSISTENCE OF MAINTENANCE ONCE- OR TWICE-DAILY ORAL DISEASE-MODIFYING DRUGS (DIMETHYL FUMARATE, FINGOLIMOD, AND TERIFLUNOMIDE) IN MULTIPLE SCLEROSIS

Abstract

To conduct meta-analyses of reported rates of once- or twice-daily oral maintenance disease-modifying drugs (DMDs) (ie, dimethyl fumarate, fingolimod, and teriflunomide) adherence and/or persistence across real-world data sources in patients with multiple sclerosis (MS). A systematic literature review of studies published between January 2010-April 2018 evaluating adherence and/or persistence with once- or twice-daily oral DMDs was performed. Two individuals reviewed search results and reference lists of articles and 3 individuals extracted data. The quality of selected studies was evaluated using a modified version of the Newcastle-Ottawa Scale. Fixed-effects models (FEMs) or random-effects models (REMs) were evaluated for pooling summary estimates of nonadherence by the specific adherence measures. Cochran’s Q test evaluated if heterogeneity existed between estimates of the population parameter, and the I2 statistic helped discern the source of the hetereogeneity. Egger’s test was used to detect publication bias. From 510 citations, 31 studies comprising 16,398 patients with MS were included. Significant Cochran’s Q and I2 >50% confirmed the use of REMs. The absence of significance for the Egger’s test suggests publication bias was not present. The overall 1-year mean medication possession ratio (MPR; n=4 studies) for oral DMDs was 83.3% (95% confidence interval [CI] 74.5%-92.1%) and the overall 1-year mean proportion of days covered (PDC; n=4 studies) was 76.5% (95% CI 72.0%-81.1%). The pooled MPR ≥80% adherence rate across studies (n=6) was 78.5% (95% CI 63.5%-88.5%) and the pooled PDC ≥80% adherence rate (n=5 studies) was 71.8% (95% CI 59.1%-81.9%). The pooled discontinuation rate across studies (n=20) for oral DMDs was 25.4% (95% CI 21.6%-29.7%). This meta-analysis of real-world studies showed that one in five (1/5) patients with MS do not adhere to once- or twice-daily oral maintenance DMDs and one in four (1/4) discontinue DMDs before one year. Opportunities to improve adherence in patients with MS remain.