A cross-sectional analysis of persistence to disease-modifying therapies in treatment naïve and experienced patients with relapsing multiple sclerosis at a health-system specialty pharmacy

Kozlicki, Miranda; Markley, Brandon; Shah, Neha; DeClercq, Josh; Choi, Leena; Zuckerman, Autumn D

doi:10.1016/j.msard.2022.103860

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Specifically, pwMS in the 2L + OCR cohort were required to discontinue their first-line DMT; therefore, some pwMS in the 2L + OCR cohort may have experienced breakthrough disease during their first treatment, which may be suggestive of more severe disease. However, changes in plan formularies or preferred drug lists are also common reasons for changes in MS treatment [ 61 ]. In addition, pwMS in the 2L + OCR cohort may have initiated their first-line DMT prior to the approval of OCR in March 2017 and therefore changed treatment after OCR became available for pwMS.…”

Section: Limitationsmentioning

confidence: 99%

Real-World Clinical and Economic Outcomes Among Persons With Multiple Sclerosis Initiating First- Versus Second- or Later-Line Treatment With Ocrelizumab

Geiger¹,

Sheinson²,

To³

et al. 2023

Neurol Ther

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Introduction Prior research has demonstrated that early treatment with high-efficacy disease-modifying therapies (DMTs), including ocrelizumab (OCR), can reduce relapses and delay disease progression among persons with multiple sclerosis (pwMS) compared with escalation from low-/moderate-efficacy DMTs. However, there is a lack of research examining the impact of early use of OCR on real-world clinical and economic outcomes. This study aimed to evaluate differences in events often associated with a relapse (EOAR) as well as non-DMT healthcare resource use (HCRU) and costs among pwMS who received OCR as a first-line treatment compared with later-line treatment after diagnosis. Methods Newly diagnosed adult pwMS were selected from deidentified Optum Market Clarity claims data (study period: January 1, 2015–June 30, 2021). All pwMS were required to have initiated OCR after diagnosis and have 12 months of continuous eligibility prior to diagnosis. The index date was the date of initiation of the first-line DMT after diagnosis. pwMS who initiated OCR as first-line (1L OCR cohort) or a second- or later-line treatment (2L + OCR cohort) were matched 1:1 based on length of continuous eligibility after the first-line DMT and weighted using stabilized inverse probability of treatment. In the follow-up period, differences in outcomes, including annualized EOAR, non-DMT HCRU and costs, were evaluated for pwMS in the 1L vs. 2L + OCR cohorts. Results The sample included 748 pwMS. During the follow-up period, pwMS in the 1L OCR cohort had a significantly lower annual rate of EOAR compared with pwMS in the 2L + OCR cohort (0.37 vs. 0.56; difference: 0.20 [95% CI 0.08, 0.32]). pwMS in the 1L OCR cohort had a significantly lower probability of any hospitalization within 1 year, fewer non-DMT outpatient visits and lower all-cause and MS-related, non-DMT costs compared with pwMS in the 2L + OCR cohort. Conclusions First-line initiation OCR was associated with improvements in clinical and non-DMT economic outcomes compared with later-line initiation of OCR, suggesting that early initiation may benefit both patients and the healthcare system. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-023-00523-3.

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Section: Limitationsmentioning

confidence: 99%

Real-World Clinical and Economic Outcomes Among Persons With Multiple Sclerosis Initiating First- Versus Second- or Later-Line Treatment With Ocrelizumab

Geiger¹,

Sheinson²,

To³

et al. 2023

Neurol Ther

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“…Furthermore, switching DMTs can be a negative emotional experience due to uncertainty around efficacy, change in administration routine, and risk profile [4]. The two most common reasons that prompt DMT switching at a population level appear to be lack of efficacy and side effects [5][6][7][8][9][10][11], although there are limited comparative data on the most common reasons for stopping individual DMTs.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have reported a wide range of estimates for 12-month persistence on any single DMT, ranging from 45% to 97%, and falling to 50%-60% by years 2-4 [5,6,[13][14][15][16][17][18][19][20][21][22][23][24][25]. Very few data are available on longer term DMT persistence.…”

Section: Introductionmentioning

confidence: 99%

“…Claims‐based studies have mostly focussed on injectable (beta‐interferon [IFN] and glatiramer acetate [GA]) or oral DMTs, whereas registry studies tend to offer broader comparisons between DMTs [12]. Studies have reported a wide range of estimates for 12‐month persistence on any single DMT, ranging from 45% to 97%, and falling to 50%–60% by years 2–4 [5, 6, 13–25]. Very few data are available on longer term DMT persistence.…”

Section: Introductionmentioning

confidence: 99%

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Real‐world persistence of multiple sclerosis disease‐modifying therapies

Tallantyre,

Dobson,

Froud

et al. 2024

Euro J of Neurology

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Background and purposeTreatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real‐world rates of persistence on disease‐modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation.MethodsTreatment data on 4366 consecutive people with relapse‐onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan–Meier survival analyses were used to express DMT persistence.ResultsIn 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1–4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate.ConclusionsImmune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.

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Adherence and persistence to self-administered disease-modifying therapies in patients with multiple sclerosis: A multisite analysis

Zuckerman¹,

DeClercq²,

Simonson³

et al. 2023

Multiple Sclerosis and Related Disorders

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A cross-sectional analysis of persistence to disease-modifying therapies in treatment naïve and experienced patients with relapsing multiple sclerosis at a health-system specialty pharmacy

Cited by 7 publications

References 21 publications

Real-World Clinical and Economic Outcomes Among Persons With Multiple Sclerosis Initiating First- Versus Second- or Later-Line Treatment With Ocrelizumab

Real-World Clinical and Economic Outcomes Among Persons With Multiple Sclerosis Initiating First- Versus Second- or Later-Line Treatment With Ocrelizumab

Real‐world persistence of multiple sclerosis disease‐modifying therapies

Adherence and persistence to self-administered disease-modifying therapies in patients with multiple sclerosis: A multisite analysis

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