PND55 - And Then There Were Three; The Burgeoning Market Of Oral Medications Approved To Treat Multiple Sclerosis In The United States

Abstract

The first oral disease modifying therapy (DMT) was approved in the fall of 2010, the second followed two years later with a short six-month gap before the third approval. This study sought to describe and compare patients prescribed one of the three oral DMTs available to treat relapsing forms of multiple sclerosis (MS) in the US. Adult patients with a claim for fingolimod, teriflunomide or dimethyl fumarate on or after September 22, 2010 (‘index’) were identified in the Truven Health MarketScan® databases. Patients had an MS diagnosis (ICD-9-CM 340) in the 12 months prior to index, continuous enrollment 12 months pre- and 3 months post-index and a confirmatory claim for their index drug. Demographic, clinical and severity characteristics were measured and compared in the 12 month baseline period. A total of 3,379 patients were included, mean age 46.3 (SD 10.5), 75.4% female. The majority (85.8%, n=2,899) indexed on fingolimod, with 10.0% (n=339) indexing on teriflunomide and the remaining 4.2% (n=141) indexing on dimethyl fumarate. Patients indexing on teriflunomide and dimethyl fumarate were significantly older than those indexing on fingolimod (50.0 [SD 9.6] and 48.1 [SD 10.4] vs. 45.8 (SD 10.2), respectively, both p<0.01). A greater proportion of patients indexing on teriflunomide had chronic pain, high blood pressure and high cholesterol than those indexing on fingolimod (47.2% vs.40.8%, 30.4% vs. 19.7% and 24.5% vs. 15.8%, respectively, all p<0.05) and a greater proportion of patients indexing on dimethyl fumarate had arthritis and thyroid disease than those indexing on fingolimod (13.5% vs. 6.9% and 13.5% vs. 8.1%, both p<0.05). Factors in the decision to start disease modifying therapy with one of the oral medications can be complex. This study showed that older patients with more comorbid disease are being channeled to the two newest oral medications on the market.