<p>Comparative Adherence Trajectories of Oral Fingolimod and Injectable Disease Modifying Agents in Multiple Sclerosis</p>

Abstract

Background Oral fingolimod is convenient to use than injectable disease modifying agents (DMAs) in patients with multiple sclerosis (MS). However, the existing literature regarding the comparative adherence trajectories between oral fingolimod and injectable DMAs is limited. Objective To compare the adherence trajectories between oral DMA, fingolimod, and injectable DMAs in patients with MS. Methods A retrospective longitudinal study was conducted using adults (≥18 years) with MS (ICD-9-CM: 340 and a DMA prescription) from the IBM MarketScan Commercial Claims and Encounters Database between 2010 and 2012. Patients were grouped into oral fingolimod or injectable DMA users based on the index DMA among patients with MS. The annual DMA adherence trajectories, based on the proportion of days covered (PDC), were examined using group-based trajectory modeling (GBTM) during the one-year follow-up period after treatment initiation. Multivariable multinomial logistic regression using stabilized inverse probability treatment weights (IPTW) was performed to assess the association between the DMA route of administration (Oral vs Injectable) and the adherence trajectory groups. The balance of covariates between oral and injectable DMAs before and after IPTW was checked against a standardized difference threshold of 0.25. Results The study cohort consisted of 1,700 MS patients who were initiated with oral (15.8%) or injectable (84.2%) DMAs between 2010 and 2012. The adherence rates (PDC≥0.8) in oral fingolimod and injectable DMA users were found to be 64.7% and 50.8%, respectively. The GBTM grouped individuals in the study cohort into three adherence trajectories – rapid discontinuers (23.5%), complete adherers (49.9%), and slow decliners (26.6%). The multinomial logistic regression model with stabilized IPTW revealed that oral fingolimod users had higher odds to be a complete adherer (adjusted odds ratio [AOR]: 2.78, 95% CI: 1.85–4.16) or a slow discontinuer (AOR: 2.62, 95% CI: 1.70–4.05) than injectable DMA users. Conclusions Oral DMA fingolimod was associated with better adherence than injectable DMAs across group-based trajectories. Further research is warranted to evaluate the adherence trajectories with newer oral DMAs introduced in the last decade for MS.

Static and group-based trajectory analyses of factors associated with non-adherence in patients with multiple sclerosis newly-initiating once- or twice-daily oral disease-modifying therapy

“…Previously published studies in patients with MS have utilized GBTM to assess MS disease course 26 and disability outcomes. 27 One previously published study compared adherence trajectories between fingolimod and self-injectable DMTs in patients with MS. 28 Similar to the current study, the authors found that GBTM grouped individuals in the study cohort into three adherence trajectories—complete adherers (49.9%), slow decliners (26.6%), and rapid discontinuers (23.5%). 28 A multinomial logistic regression model found that oral fingolimod users had higher odds of being a complete adherer (adjusted odds ratio [AOR]: 2.78, 95% CI: 1.85–4.16) or a slow discontinuer (AOR: 2.62, 95% CI: 1.70–4.05) compared with injectable DMT users.…”

“… 27 One previously published study compared adherence trajectories between fingolimod and self-injectable DMTs in patients with MS. 28 Similar to the current study, the authors found that GBTM grouped individuals in the study cohort into three adherence trajectories—complete adherers (49.9%), slow decliners (26.6%), and rapid discontinuers (23.5%). 28 A multinomial logistic regression model found that oral fingolimod users had higher odds of being a complete adherer (adjusted odds ratio [AOR]: 2.78, 95% CI: 1.85–4.16) or a slow discontinuer (AOR: 2.62, 95% CI: 1.70–4.05) compared with injectable DMT users. 28 The overall 1-year static DMT adherence rate observed in the current study is also consistent with other studies assessing oral DMT adherence, which have considered smaller populations receiving an oral DMT for treatment of MS. 5 , 15 , 29 – 32 …”

“… 28 A multinomial logistic regression model found that oral fingolimod users had higher odds of being a complete adherer (adjusted odds ratio [AOR]: 2.78, 95% CI: 1.85–4.16) or a slow discontinuer (AOR: 2.62, 95% CI: 1.70–4.05) compared with injectable DMT users. 28 The overall 1-year static DMT adherence rate observed in the current study is also consistent with other studies assessing oral DMT adherence, which have considered smaller populations receiving an oral DMT for treatment of MS. 5 , 15 , 29 – 32 …”

Comparative adherence trajectories of oral disease‐modifying agents in multiple sclerosis

“…9,16 As per recent literature, adherence was superior among oral DMA users relative to injectable DMA users. 14,[17][18][19] Further, adherence among different oral DMAs could vary due to differences in dosing frequency, efficacy, and toxicity profiles. Previous studies showed that FIN users had better adherence and lower discontinuation rates than TER and DMF users.…”

The Quality of Life and Medication Adherence in Patients with Multiple Sclerosis—Cross-Sectional Study

“…Previous studies have shown that patients more preferably use oral pharmacotherapy [ 46 , 47 , 48 ]. Therefore, the level of adherence among patients taking oral drugs is higher than those taking injectable drugs.…”