Healthcare resource utilization following switch or discontinuation in multiple sclerosis patients on disease modifying drugs

Abstract

Changing or discontinuing DMDs is common among MS patients and is associated with higher non-pharmaceutical medical costs that vary based on the initiating drug and other demographics characteristics.

Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis

“…Discontinuations due to these reasons can lead to a switch in DMT. Switches can result in increased non-pharmacy costs 41 and may be associated with a break in disease control, as some DMTs take time to become fully effective; for example, GA may take to up 9 months to reach its maximum effectiveness 42 . However, switches can also be beneficial to patients, particularly if they have switched due to experiencing breakthrough disease on injectable therapies to a more efficacious therapy.…”

Increased Relapse Activity for Multiple Sclerosis Natalizumab Users Who Become Nonpersistent: A Retrospective Study

“…Persistence in annual follow-up periods was defined as no gap in natalizumab claims greater than 90 days, which is similar to other claims-based studies. 16,23 Nonpersistence was defined as switched to another DMT (i.e., use of 2 or more DMTs within a year and no 90-day or greater gap on the final DMT used at the end of the year); discontinued natalizumab (i.e., no natalizumab or other DMT claim for at least the last 90-day period in the year following natalizumab initiation); or had at least one 90-day or greater gap in natalizumab claims during a calendar year after natalizumab initiation with subsequent natalizumab or other DMT use that did not fall into the switch definition.…”

“…16,23 There were 2 main reasons that we chose to merge switching and discontinuation into the category of nonpersistence: (1) there was little statistical difference in baseline characteristics between the subcategories switch, discontinue, and a 90-day or greater gap following natalizumab initiation (Appendix A, available in online article); and (2) the goal of this analysis was to examine the global impact of using natalizumab consistently as compared with inconsistent natalizumab use, even if that involved switching to another therapy or discontinuing. Merging these groups expanded the traditional definition of nonpersistence to include not only gaps in therapy, but also the clinical failure or intolerability of natalizumab.…”

“…[16][17][18][19][20] Some studies have measured persistence and linked behavior to relapse outcomes; [21][22][23][24][25][26][27][28] however, few have focused specifically on natalizumab, [13][14][15]24,29 and of those studies, none have focused on natalizumab treatment patterns and the resulting impact on relapse-related outcomes in a large U.S. commercially insured population.…”

Perspectives for Managed Care Organizations on the Burden of Multiple Sclerosis and the Cost-Benefits of Disease-Modifying Therapies

“…Patient-level administrative claims data were obtained from the IMS LifeLink Health Plan Claims Database, a large data warehouse of administrative claims that has been used for previous analyses of data on patients with MS. [26][27][28] At the time these analyses were conducted, the database patients with CIS. [8][9][10][11][12] Although head-to-head clinical trials are lacking in this patient population, the adjusted reductions in the risk of CDMS were generally similar with GA, IFNβ-1a, and IFNβ-1b (ranging from 35% with subcutaneous [SC] IFNβ-1a to 55% with intramuscular [IM] IFNβ-1a over 2 to 3 years).…”