Comparison of adherence and persistence among multiple sclerosis patients treated with disease-modifying therapies: a retrospective administrative claims analysis

Abstract

Purpose:To compare adherence and persistence among patients with multiple sclerosis (MS) initiated on disease-modifying therapy (DMTs), including intramuscular (IM) interferon beta-1a (IFNβ-1a), subcutaneous (SC) IFNβ-1a, IFNβ-1b, or glatiramer acetate (GA).Methods:MS patients initiated on IM-IFNβ-1a, SC-IFNβ-1a, IFNβ-1b, or GA between January 1, 2000 and January 2, 2008 were identified from a retrospective claims database study associated with a large US health plan. The date of DMT initiation was the index date; patients were observed for 6 months before and 12–36 months after the index date. Adherence to the index DMT was measured with a medication possession ratio (MPR), the proportion of days patients possessed their index DMTs; MPR ≥ 0.80 was considered adherent. Persistence was time in days from index date until the earlier of a minimum 60-day gap in DMT therapy or the last DMT claim during follow-up. Adherence and persistence were modeled with logistic and Cox proportional hazard regressions, respectively.Results:The study population comprised 6,680 patients in the DMT cohorts: IM-IFNβ-1a (N = 2,305, 34.5%); IFNβ-1b (N = 894, 13.4%); GA (N = 2,270, 34.0%); and SC-IFNβ-1a (N = 1,211, 18.1%). The IM-IFNβ-1a cohort had significantly higher regression-adjusted odds of adherence relative to the other cohorts: 52.4% higher odds versus the IFNβ-1b cohort (OR = 0.656, CI = 0.561–0.768); 33.5% higher odds versus the GA cohort (OR = 0.749, CI = 0.665–0.844); and 20.6% higher odds versus the SC-IFNβ-1a cohort (OR = 0.829, CI = 0.719–0.957). There were no consistent differences in persistence between the cohorts.Conclusion:IM-IFNβ-1a patients had significantly higher odds of adherence compared with other DMT cohorts, possibly attributable to IM-IFNβ-1a’s less frequent dosing schedule. The benefits of adherence may include better quality of life, lower risk of relapse, and fewer hospitalizations and emergency visits, making adherence a critical component of MS management.

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

“…Halpern et al 26 reported lower rates of adherence for GA and IFN (52.2-62.3% of patients) and Tan et al 19 reported a combined rate of 59.6%; however, both of these studies required patients to have only one claim for the index DMT (not at least two claims as in our study), and both had substantially longer follow-up periods than in our study (1-3 years and 4 years, respectively). Another 4-year study reported adherence rates of 52.2-62.3% for GA and IFNs 27 . Similar rates were also reported in a review that included 24 studies of adherence to DMTs, with weighted mean adherence rates for GA and IFNs ranging between 56.8% and 69.4% 43 .…”

“…Several studies have shown that adherence to, and persistence with, DMTs are associated with a reduced risk of relapse 22,23 , reduced healthcare resource utilization 22 , reduced incidence of MS-related hospitalization 19 , and improved health-related quality-of-life 24,25 in patients with MS. First-line injectable DMTs are associated with sub-optimal rates of adherence and persistence 20,22,[26][27][28][29] , and treatment-related issues, such as unresponsiveness and intolerance to GA or IFNs, prompt patients to discontinue or switch therapy 30,31 . A review of DMT discontinuation rates across several countries found that 16-27% of patients discontinued GA or IFN therapy prematurely within 24 months of follow-up, increasing to 43% for GA and up to 34% for IFNs when patients were followed for longer than 24 months 32 .…”

“…A US claims database analysis reported discontinuation rates of 43.8% for GA and 44.8-53.9% for IFNs for treatment-naïve patients within 12 months of treatment initiation 33 . A recent retrospective claims database analysis of nearly 7000 patients with MS in the US reported that only 55% and 52-62% of patients were adherent (measured as a medication possession ratio [MPR] 80%) to GA and IFNs, respectively, over 12-36 months 27 . Another study that included only IFNs reported that 27-41% of patients were adherent (MPR 85%) in each year of the study, with only 4% of patients being continuously adherent throughout the 3-year study 22 .…”

Adesão ao tratamento para esclerose múltipla com terapias de primeira linha: análise longitudinal retrospectiva

“…8,[11][12][13][14]16 A média ponderada do desfecho MPR>0,80 dos três estudos identificados que envolveram ao todo 43.372 pacientes foi de 48,99% para Avonex®, 40,72% para Betaferon® e 43,06% para Rebif®. (11,12,14) Já a média ponderada do MPR em cinco estudos envolvendo cerca de 45 mil pacientes foi de 67,08%, 58,31% e 64,61% para Avonex®, Betaferon® e Rebif®, respectivamente.…”

“…7 Tal decisão foi baseada no Relatório de Recomendação nº 261, de maio de 2016, da Comissão Nacional [8][9][10][11][12][13][14][15][16][17][18][19] Ao identificar a dicotomia dos dois conjuntos de evidências descritos acima (i.e., monitoramento da incorporação versus literatura científica), avaliamos as principais discrepâncias entre os referidos grupos de informações e apontamos as seguintes falhas metodológicas no estudo de monitoramento da incorporação das betainterferonas no SUS, sendo:…”