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Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis.
J Med Econ 2014; 17(10):696-707JM

Abstract

OBJECTIVE

Achieving therapeutic goals in multiple sclerosis (MS) requires strict adherence to treatment schedules. This retrospective study analyzed persistence with, and adherence to, fingolimod compared with injectable/infusible disease-modifying therapies (DMTs) in patients with MS.

METHODS

Patients in the PharMetrics Plus™ US administrative claims database with at least one prescription for, or administration of, fingolimod, glatiramer acetate (GA), interferon (IFN), or natalizumab (index DMT) between October 1, 2010 and September 30, 2011 were included. Patients were naïve to index DMT (no claim in the previous 360 days) and had an MS diagnosis code within 360 days of the first index DMT prescription. Outcomes were persistence, risk of discontinuing index DMT (evaluated by a Cox proportional hazards model), adherence (measured using the medication possession ratio [MPR] and proportion of days covered [PDC] in patients with at least two index DMT prescriptions), and the risk of being non-adherent (MPR <80% and PDC <80%, assessed using a logistic regression model).

RESULTS

The study included 3750 patients (fingolimod, n = 889; GA, n = 1233; any IFN, n = 1341; natalizumab, n = 287). Discontinuation rates (fingolimod, 27.9%; GA, 39.5%; IFN, 43.7%; natalizumab, 39.5%; all p < 0.001) and risk of discontinuation were significantly higher (hazard ratios vs fingolimod [95% confidence interval]: GA, 1.75 [1.49-2.07]; IFN, 2.01 [1.71-2.37]; natalizumab, 1.53 [1.22-1.91]) for patients receiving other DMTs compared with fingolimod. The risk of being non-adherent was also lower for patients in the fingolimod cohort than the other treatment cohorts, irrespective of whether non-adherence was defined as MPR <80% (p < 0.05 for all) or PDC <80% (p < 0.05 for GA and IFN).

LIMITATIONS

As with all studies assessing real-world treatment patterns it is unclear if medications were used as prescribed.

CONCLUSIONS

In a real-world setting, persistence with, and adherence to, oral fingolimod was higher than for injectable and infusible DMTs.

Authors+Show Affiliations

Novartis Pharma AG , Basel , Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25019581

Citation

Bergvall, Niklas, et al. "Persistence With and Adherence to Fingolimod Compared With Other Disease-modifying Therapies for the Treatment of Multiple Sclerosis: a Retrospective US Claims Database Analysis." Journal of Medical Economics, vol. 17, no. 10, 2014, pp. 696-707.
Bergvall N, Petrilla AA, Karkare SU, et al. Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. J Med Econ. 2014;17(10):696-707.
Bergvall, N., Petrilla, A. A., Karkare, S. U., Lahoz, R., Agashivala, N., Pradhan, A., ... Korn, J. R. (2014). Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. Journal of Medical Economics, 17(10), pp. 696-707. doi:10.3111/13696998.2014.940422.
Bergvall N, et al. Persistence With and Adherence to Fingolimod Compared With Other Disease-modifying Therapies for the Treatment of Multiple Sclerosis: a Retrospective US Claims Database Analysis. J Med Econ. 2014;17(10):696-707. PubMed PMID: 25019581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. AU - Bergvall,Niklas, AU - Petrilla,Allison A, AU - Karkare,Swapna U, AU - Lahoz,Raquel, AU - Agashivala,Neetu, AU - Pradhan,Ashish, AU - Capkun,Gorana, AU - Makin,Charles, AU - McGuiness,Catherine Balderston, AU - Korn,Jonathan R, Y1 - 2014/07/23/ PY - 2014/7/15/entrez PY - 2014/7/16/pubmed PY - 2015/6/9/medline KW - Adherence KW - Fingolimod KW - Glatiramer acetate KW - Interferon KW - Multiple sclerosis KW - Natalizumab KW - Persistence SP - 696 EP - 707 JF - Journal of medical economics JO - J Med Econ VL - 17 IS - 10 N2 - OBJECTIVE: Achieving therapeutic goals in multiple sclerosis (MS) requires strict adherence to treatment schedules. This retrospective study analyzed persistence with, and adherence to, fingolimod compared with injectable/infusible disease-modifying therapies (DMTs) in patients with MS. METHODS: Patients in the PharMetrics Plus™ US administrative claims database with at least one prescription for, or administration of, fingolimod, glatiramer acetate (GA), interferon (IFN), or natalizumab (index DMT) between October 1, 2010 and September 30, 2011 were included. Patients were naïve to index DMT (no claim in the previous 360 days) and had an MS diagnosis code within 360 days of the first index DMT prescription. Outcomes were persistence, risk of discontinuing index DMT (evaluated by a Cox proportional hazards model), adherence (measured using the medication possession ratio [MPR] and proportion of days covered [PDC] in patients with at least two index DMT prescriptions), and the risk of being non-adherent (MPR <80% and PDC <80%, assessed using a logistic regression model). RESULTS: The study included 3750 patients (fingolimod, n = 889; GA, n = 1233; any IFN, n = 1341; natalizumab, n = 287). Discontinuation rates (fingolimod, 27.9%; GA, 39.5%; IFN, 43.7%; natalizumab, 39.5%; all p < 0.001) and risk of discontinuation were significantly higher (hazard ratios vs fingolimod [95% confidence interval]: GA, 1.75 [1.49-2.07]; IFN, 2.01 [1.71-2.37]; natalizumab, 1.53 [1.22-1.91]) for patients receiving other DMTs compared with fingolimod. The risk of being non-adherent was also lower for patients in the fingolimod cohort than the other treatment cohorts, irrespective of whether non-adherence was defined as MPR <80% (p < 0.05 for all) or PDC <80% (p < 0.05 for GA and IFN). LIMITATIONS: As with all studies assessing real-world treatment patterns it is unclear if medications were used as prescribed. CONCLUSIONS: In a real-world setting, persistence with, and adherence to, oral fingolimod was higher than for injectable and infusible DMTs. SN - 1941-837X UR - https://www.unboundmedicine.com/medline/citation/25019581/Persistence_with_and_adherence_to_fingolimod_compared_with_other_disease_modifying_therapies_for_the_treatment_of_multiple_sclerosis:_a_retrospective_US_claims_database_analysis_ L2 - http://www.tandfonline.com/doi/full/10.3111/13696998.2014.940422 DB - PRIME DP - Unbound Medicine ER -