Tags

Type your tag names separated by a space and hit enter

Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study.
BMC Neurol 2013; 13:138BN

Abstract

BACKGROUND

Adherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS). Patients with lower adherence rates experience more inpatient visits and higher MS-related medical costs. Fingolimod, the first oral DMT approved by the US Food and Drug Administration, may improve the access and compliance to MS treatment when compared to injectable DMTs.

METHODS

This retrospective cohort study used pharmacy claims from Medco Health Solutions, Inc., of patients who initiated DMTs between October 2010 and February 2011. Initiation was defined as no prescription fills for the same DMT in the prior 12 months. Patients without a DMT prescription fill 12 months before the index date were considered naïve users. Compliance was measured via proportion of days covered (PDC) and medication possession ratio (MPR) for 12 months post-index. Discontinuation was defined as a ≥60-day gap of index DMT supply. Cox proportional hazard models compared time to discontinuation between cohorts.

RESULTS

Of 1,891 MS patients (mean age: 45.7; female: 76.4%), 13.1% initiated fingolimod, 10.7% interferon beta-1b, 20.0% intramuscular interferon beta-1a, 18.8% subcutaneous interferon beta-1a, and 37.4% glatiramer acetate. Patients initiating fingolimod had highest average PDC and MPR in both experienced (fingolimod: mean PDC=0.83, 73.7% with PDC≥0.8; mean MPR=0.92, 90.5% with MPR≥0.8) and naïve DMT users (fingolimod: mean PDC=0.80, 66.7% with PDC≥0.8; mean MPR=0.90, 87.4% with MPR≥0.8). The proportion of patients discontinuing index DMT within 12 months was significantly lower for the fingolimod cohort (naïve: 31.3%; experienced: 25.7%). Adjusted results found that patients receiving self-injected DMTs discontinued significantly sooner than fingolimod users. This association was generally stronger in experienced DMT users.

CONCLUSIONS

Fingolimod initiators were more compliant, less likely to discontinue treatment, and discontinued later than patients who initiated self-injected DMT.

Authors+Show Affiliations

Novartis Pharmaceuticals Corporation, One Health Plaza, 07936, East Hanover, NJ USA. neetu.agashivala@novartis.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24093542

Citation

Agashivala, Neetu, et al. "Compliance to Fingolimod and Other Disease Modifying Treatments in Multiple Sclerosis Patients, a Retrospective Cohort Study." BMC Neurology, vol. 13, 2013, p. 138.
Agashivala N, Wu N, Abouzaid S, et al. Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study. BMC Neurol. 2013;13:138.
Agashivala, N., Wu, N., Abouzaid, S., Wu, Y., Kim, E., Boulanger, L., & Brandes, D. W. (2013). Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study. BMC Neurology, 13, p. 138. doi:10.1186/1471-2377-13-138.
Agashivala N, et al. Compliance to Fingolimod and Other Disease Modifying Treatments in Multiple Sclerosis Patients, a Retrospective Cohort Study. BMC Neurol. 2013 Oct 4;13:138. PubMed PMID: 24093542.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study. AU - Agashivala,Neetu, AU - Wu,Ning, AU - Abouzaid,Safiya, AU - Wu,You, AU - Kim,Edward, AU - Boulanger,Luke, AU - Brandes,David W, Y1 - 2013/10/04/ PY - 2013/01/14/received PY - 2013/09/26/accepted PY - 2013/10/8/entrez PY - 2013/10/8/pubmed PY - 2014/4/5/medline SP - 138 EP - 138 JF - BMC neurology JO - BMC Neurol VL - 13 N2 - BACKGROUND: Adherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS). Patients with lower adherence rates experience more inpatient visits and higher MS-related medical costs. Fingolimod, the first oral DMT approved by the US Food and Drug Administration, may improve the access and compliance to MS treatment when compared to injectable DMTs. METHODS: This retrospective cohort study used pharmacy claims from Medco Health Solutions, Inc., of patients who initiated DMTs between October 2010 and February 2011. Initiation was defined as no prescription fills for the same DMT in the prior 12 months. Patients without a DMT prescription fill 12 months before the index date were considered naïve users. Compliance was measured via proportion of days covered (PDC) and medication possession ratio (MPR) for 12 months post-index. Discontinuation was defined as a ≥60-day gap of index DMT supply. Cox proportional hazard models compared time to discontinuation between cohorts. RESULTS: Of 1,891 MS patients (mean age: 45.7; female: 76.4%), 13.1% initiated fingolimod, 10.7% interferon beta-1b, 20.0% intramuscular interferon beta-1a, 18.8% subcutaneous interferon beta-1a, and 37.4% glatiramer acetate. Patients initiating fingolimod had highest average PDC and MPR in both experienced (fingolimod: mean PDC=0.83, 73.7% with PDC≥0.8; mean MPR=0.92, 90.5% with MPR≥0.8) and naïve DMT users (fingolimod: mean PDC=0.80, 66.7% with PDC≥0.8; mean MPR=0.90, 87.4% with MPR≥0.8). The proportion of patients discontinuing index DMT within 12 months was significantly lower for the fingolimod cohort (naïve: 31.3%; experienced: 25.7%). Adjusted results found that patients receiving self-injected DMTs discontinued significantly sooner than fingolimod users. This association was generally stronger in experienced DMT users. CONCLUSIONS: Fingolimod initiators were more compliant, less likely to discontinue treatment, and discontinued later than patients who initiated self-injected DMT. SN - 1471-2377 UR - https://www.unboundmedicine.com/medline/citation/24093542/Compliance_to_fingolimod_and_other_disease_modifying_treatments_in_multiple_sclerosis_patients_a_retrospective_cohort_study_ L2 - https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-13-138 DB - PRIME DP - Unbound Medicine ER -