Use of the new oral disease-modifying therapies for multiple sclerosis in British Columbia, Canada: the first five-years

Abstract

Background: Little is known about the use of the new oral disease-modifying therapies (DMTs: fingolimod, dimethyl fumarate, teriflunomide) for multiple sclerosis (MS) in clinical practice. We describe their rate of uptake, and their use as compared to the established first-generation (beta-interferon and glatiramer acetate) and second-generation (natalizumab and alemtuzumab) parenteral DMTs.Methods: Persons with MS (PwMS) were identified using health administrative data from British Columbia, Canada (2011-15). We described the uptake and use of the DMTs with Poisson and Log-Binomial regression, adjusting for sex, age, and socioeconomic status (SES).Results: Among 14,148 PwMS, 2,821 were exposed to any DMT over the study period. In total, 1,019 initiated an oral DMT, a rate of 16.6/1,000 person-year, and 83/1,000 PwMS filled at least one prescription for an oral DMT during the study period. The rate of uptake for oral DMTs, and the annual proportion of PwMS using an oral DMT or second-generation parenteral DMT increased over the 5 years, whereas use of the first-generation DMTs decreased by 30%. PwMS in the higher (vs. lower) SES group had a 19-44% higher rate of uptake for teriflunomide and fingolimod.Conclusion: The uptake and use of the oral DMTs increased substantially over the first 2 to 5 years after their introduction. These recent changes highlight the importance of monitoring the risks and benefits in the real world.