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Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study
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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851325/ https://www.ncbi.nlm.nih.gov/pubmed/24093542 http://dx.doi.org/10.1186/1471-2377-13-138 |
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author | Agashivala, Neetu Wu, Ning Abouzaid, Safiya Wu, You Kim, Edward Boulanger, Luke Brandes, David W |
author_facet | Agashivala, Neetu Wu, Ning Abouzaid, Safiya Wu, You Kim, Edward Boulanger, Luke Brandes, David W |
author_sort | Agashivala, Neetu |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3851325 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-38513252013-12-06 Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study Agashivala, Neetu Wu, Ning Abouzaid, Safiya Wu, You Kim, Edward Boulanger, Luke Brandes, David W BMC Neurol Research Article 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. BioMed Central 2013-10-04 /pmc/articles/PMC3851325/ /pubmed/24093542 http://dx.doi.org/10.1186/1471-2377-13-138 Text en Copyright © 2013 Agashivala et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Agashivala, Neetu Wu, Ning Abouzaid, Safiya Wu, You Kim, Edward Boulanger, Luke Brandes, David W Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
title | Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
title_full | Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
title_fullStr | Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
title_full_unstemmed | Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
title_short | Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
title_sort | compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851325/ https://www.ncbi.nlm.nih.gov/pubmed/24093542 http://dx.doi.org/10.1186/1471-2377-13-138 |
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