Changing therapeutic strategies and persistence to disease-modifying treatments in a population of multiple sclerosis patients from Veneto region, Italy

Marangi, Antonio; Farina, Gabriele; Vicenzi, Virginia; Forlivesi, Stefano; Calabria, Francesca; Marchioretto, Fabio; Forgione, Antonio; Rossi, Francesca; Stenta, Gianola; Vianello, Marika; Gajofatto, Alberto; Benedetti, Maria Donata

doi:10.1016/j.msard.2020.102004

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…Our case-finding algorithm has 99.0% sensitivity, and is applied on 10% of the Italian population [ 15 ]. Of note, our demographics and Interferon Beta prescription rates are in line with international studies conducted within the same time frame, on equally sized populations [ 26 , 31 – 34 ], thus suggesting overall generalisability of current findings.…”

Section: Discussionsupporting

confidence: 84%

“…As such, persistence rates in our study were relatively higher, when compared with previous studies [38], suggesting overall good patient profiling [10]. Some previous studies failed to find any difference in persistence between Interferon Beta formulations [31], whilst others reported on discording results [23,39]. Hereby, we found higher probability of switching to other DMTs for Betaferon®, Extavia® and Plegridy®, when compared with Rebif® and Avonex®.…”

Section: Discussionsupporting

confidence: 55%

“…Among limitations, we have to acknowledge the present study was conducted from 2015 to 2017, and, thus, our findings do not necessarily apply to the future treatment scenario of MS, which has become more complex with the introduction of new DMTs [ 3 , 31 – 33 ]. Unfortunately, there are a number of clinical variables that can affect treatment persistence and adherence (e.g., disease duration, disability, MRI measures) [ 33 , 41 , 42 ], that cannot be retrieved from routinely-collected healthcare data; in the future, data linkage to clinical registries and validation of clinical outcomes should be considered.…”

Section: Discussionmentioning

confidence: 99%

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Persistence, adherence, healthcare resource utilisation and costs for interferon Beta in multiple sclerosis: a population-based study in the Campania region (southern Italy)

Moccia

Loperto

Lanzillo

et al. 2020

BMC Health Serv Res

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Background: To differentiate five formulations of Interferon Beta for the treatment of multiple sclerosis (MS) in clinical practice, by analysing persistence, adherence, healthcare resource utilisation and costs at population level. Methods: In this population-based study, we included individuals with MS living in the Campania Region of Italy from 2015 to 2017, on treatment with intramuscular Interferon Beta-1a (Avonex® = 618), subcutaneous pegylated Interferon Beta-1a (Plegridy® = 259), subcutaneous Interferon Beta-1a (Rebif® = 1220), and subcutaneous Interferon Beta-1b (Betaferon® = 348; and Extavia® = 69). We recorded healthcare resource utilisation from administrative databases (hospital discharges, drug prescriptions, MS-related outpatients), and derived costs from the Regional formulary. We classified hospital admissions into MS-related and non-MS-related. Persistence (time to switch to other disease modifying treatments (DMTs)), and adherence (medication possession ratio (MPR) = medication supply obtained/medication supply expected during follow-up period) were calculated. Results: Patients treated with Rebif® were younger, when compared with other Interferon Beta formulations (p < 0.01). The probability of switching to other DMTs was 60% higher for Betaferon®, 90% higher for Extavia®, and 110% higher for Plegridy®, when compared with Rebif® (p < 0.01). Plegridy® presented with 7% higher adherence (p < 0.01), and Betaferon® with 3% lower adherence (p = 0.03), when compared with Rebif®. The probability of MS-related hospital admissions was 40% higher in Avonex® (p = 0.03), 400% higher in Betaferon® (p < 0.01), and 60% higher in Plegridy® (p = 0.04), resulting into higher non-DMT-related costs, when compared with Rebif®. Discussion: Interferon Beta formulations presented with different prescription patterns, persistence, adherence, healthcare resource utilisation and costs, with Rebif® being used in younger patients and with less MS-related hospital admissions.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Persistence, adherence, healthcare resource utilisation and costs for interferon Beta in multiple sclerosis: a population-based study in the Campania region (southern Italy)

Moccia

Loperto

Lanzillo

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

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“…Our ndings are in line with similar previous studies, which show that most patients treated will eventually change their therapy [10][11][12][13]. However, the treatment persistence in different studies is varied, with median time to treatment switch ranging from 25 months [12] to 50 months [10,11]. In our study, treatment persistence was longer, with a median time of 60 months.…”

Section: Discussionsupporting

confidence: 92%

Treatment Patterns and Persistence on Disease Modifying Drugs for Multiple Sclerosis and its Associated Factors

Cárdenas‐Robledo

Arenas-Vargas

Díaz

et al. 2023

Preprint

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Effective interventions for treating multiple sclerosis (MS) require prompt treatment optimization which usually involves switching disease modifying drugs (DMDs). The patterns of prescription and the reasons treatment changes, especially in low prevalence populations, are unknown. We aimed to describe the persistence, reasons of DMD switches and prescription patterns as well as their associated factors using survival and network analysis. 701 cases were included of which 94% received treatment. 29.9%, 18.7% and 11.9% of patients had one, two and three or more DMD changes, respectively, for an estimated incidence rate (95%CI) of 1.09 (1.01–1.17) per patient. The main reasons for changing DMD were disease activity, followed by non-serious adverse events and disability. Younger age at MS onset and insurer status were the main determinants of treatment change, which was not influenced by the efficacy or mode of administration of individual DMDs. Network analysis showed that interferons and fingolimod were the most central DMDs and that most DMD switches involved them.

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“…Our findings are in line with similar previous studies, which show that most pwMS treated will eventually change their therapy [ 20 – 23 ]. However, the treatment persistence in different studies varies, with median time to treatment switch ranging from 25 months [ 22 ] to 50 months [ 20 , 21 ]. In our study, treatment persistence was longer, with a median time of 60 months.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors

Cárdenas-Robledo,

Arenas-Vargas,

Arenas

et al. 2024

BMC Neurol

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Background Effective interventions for Multiple Sclerosis require timely treatment optimization which usually involves switching disease modifying therapies. The patterns of prescription and the reasons for changing treatment in people with MS, especially in low prevalence populations, are unknown. Objectives To describe the persistence, reasons of DMT switches and prescription patterns in a cohort of Colombian people with MS. Methods We conducted a retrospective observational study including patients with confirmed MS with at least one visit at our centre. We estimated the overall incidence rate of medication changes and assessed the persistence on medication with Kaplan–Meier survival estimates for individual medications and according to efficacy and mode of administration. The factors associated with changing medications were assessed using adjusted Cox proportional-hazards models. The reasons for switching medication changes were described, and the prescription patterns were assessed using network analysis, with measures of centrality. Results Seven hundred one patients with MS were included. Mean age was 44.3 years, and 67.9% were female. Mean disease duration was 11.3 years and 84.5% had relapsing MS at onset, with median EDSS of 1.0. Treatment was started in 659 (94%) of the patients after a mean of 3 years after MS symptom onset. Among them, 39.5% maintained their initial DMT, 29.9% experienced a single DMT change, while 18.7% went through two, and 11.9% had three or more DMT changes until the final follow-up. The total number of treatment modifications reached 720, resulting in an incidence rate of 1.09 (95% confidence interval: 1.01–1.17) per patient per year The median time to change after the first DMT was 3.75 years, and was not different according to the mode of administration or efficacy classification. The main reasons for changing DMT were MS activity (relapses, 56.7%; MRI activity, 18.6%), followed by non-serious adverse events (15.3%) and disability (11.1%). Younger age at MS onset, care under our centre and insurer status were the main determinants of treatment change. Network analysis showed that interferons and fingolimod were the most influential DMTs. Conclusions A majority of patients switch medications, mostly due to disease activity, and in association with age and insurer status.

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Changing therapeutic strategies and persistence to disease-modifying treatments in a population of multiple sclerosis patients from Veneto region, Italy

Cited by 8 publications

References 25 publications

Persistence, adherence, healthcare resource utilisation and costs for interferon Beta in multiple sclerosis: a population-based study in the Campania region (southern Italy)

Persistence, adherence, healthcare resource utilisation and costs for interferon Beta in multiple sclerosis: a population-based study in the Campania region (southern Italy)

Treatment Patterns and Persistence on Disease Modifying Drugs for Multiple Sclerosis and its Associated Factors

Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors

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