Impact of drug diversity on treatment effectiveness in relapsing-remitting multiple sclerosis (RRMS) in Germany between 2010 and 2018: real-world data from the German NeuroTransData multiple sclerosis registry

Abstract

ObjectiveTo evaluate the impact of drug diversity on treatment effectiveness in relapsing-remitting multiple sclerosis (RRMS) in Germany.DesignThis study employs real-world data captured in-time during clinical visits in 67 German neurology outpatient offices of the NeuroTransData (NTD) multiple sclerosis (MS) registry between 1 January 2010 and 30 June 2019, including 237 976 visits of 17 553 patients with RRMS. Adherence and clinical effectiveness parameters were analysed by descriptive statistics, time-to-event analysis overall and by disease-modifying therapies (DMTs) stratified by administration modes (injectable, oral and infusion). Three time periods were compared: 2010–2012, 2013–2015 and 2016–2018.ResultsBetween 2010 and 2018, an increasing proportion of patients with RRMS were treated with DMTs and treatment was initiated sooner after diagnosis of MS. Introduction of oral DMT temporarily induced higher readiness to switch. Comparing the three index periods, there was a continuous decrease of annualised relapse rates, less frequent Expanded Disability Status Scale (EDSS) progression and increasing periods without relapse, EDSS worsening and with stability of no-evidence-of-disease-activity 2 and 3 criteria, lower conversion rates to secondary progressive MS on oral and on injectable DMTs.ConclusionSparked by the availability of new mainly oral DMTs, RRMS treatment effectiveness improved clinically meaningful between 2010 and 2018. As similar effects were seen for injectable and oral DMTs more than for infusions, a better personalised treatment allocation in many patients is likely. These results indicate that there is an overall beneficial effect for the whole patient with MS population as a result of the greater selection of available DMTs, a benefit beyond the head-to-head comparative efficacy, resulting from an increased probability and readiness to individualise MS therapy.

Real-world disease-modifying therapy usage in persons with relapsing-remitting multiple sclerosis: Cross-sectional data from the Swiss Multiple Sclerosis Registry

“…Therefore, real-world analyses including participants independently of care setting or treatment status, are of great importance to gather insights into the real-world effectiveness of DMTs. Such studies have been conducted, but mostly in specialized populations or with a limited age range (Braune et al, 2021;Spelman et al, 2021;Turčáni et al, 2020). Furthermore, there is increasing awareness by regulatory agencies for the need to include patient-reported outcomes along with clinical outcomes in decision making.…”

Preferences, Adherence, and Satisfaction: Three Years of Treatment Experiences of People with Multiple Sclerosis

“…The proportion of participants starting infusion therapies was considerably higher at 22.2% than in a German registry with 17,553 participants who were treated by office-based neurologists during the same period (10%). 31 In contrast, injectable therapies were less frequently used in the present cohort than in the registry (26.1% vs 46%). During the study period, therapeutic strategies were shifting from an escalation paradigm (ie, generally starting with a moderately effective DMT and switching to higher efficacy DMTs only in the case of high and persistent disease activity) towards first-line use of high-efficacy DMTs for active disease, considering also MRI findings and other patient characteristics.…”

The socioeconomic impact of disability progression in multiple sclerosis: A retrospective cohort study of the German NeuroTransData (NTD) registry

“… 9 , 10 However, a lower number of MS-related hospitalizations were observed, in part explained by a decline in the annualized relapse rate (ARR) during this study observation period. 17 In addition, the NTD has a relapse treatment protocol to prevent inpatient treatment and favors ambulatory treatment of relapses. Compared with other settings, this results in lower hospitalization rates.…”

“…The NTD MS registry routinely captures demographic, medical history, socioeconomic information, patient-reported outcomes, and clinical data during visits to NTD outpatient offices, which are performed on average of approximately 3.5 times per year. 17 A standardized dataset is collected, with the minimal dataset collected at each visit, while additional data are assessed depending on medical need. All data are pseudonymized and pooled to form the NTD MS registry database.…”