Treatment Patterns Among Patients with Multiple Sclerosis Initiating Second-Line Disease-Modifying Therapy

Abstract

Objective: Disease-modifying therapies (DMTs) can reduce multiple sclerosis (MS) relapse rates; however, effectiveness of treatments may vary. It is important to understand real-world treatment patterns in the context of MS relapses. We describe MS relapses related to treatment patterns among patients who switch treatment after their first DMT. Methods: IBM MarketScan research databases were used to identify adult patients with MS who switched DMTs (index-first switch) after being newly treated with a DMT from January 2009 through March 2017, with 12 months of continuous enrollment pre-and post-index. Non-persistence was defined as discontinuing (at least 60 days without DMT) or switching DMTs. MS relapses were defined using a validated claims-based algorithm. Multivariable analysis was used to examine odds of 12-month persistence, odds of post-index relapse, and number of relapses. Results: In total, 4121 patients with MS met all inclusion criteria (mean age 46.4 years; female 76.2%). Overall, 49.6% switched to an oral DMT, 36.5% to an injectable DMT, and 13.9% to an infusion DMT. Switching DMTs resulted in a 32.4% reduction in relapses between preand post-index. Only 54.6% of patients were persistent throughout the first year. Patients who switched to oral DMTs had 95% higher adjusted odds of persistence and 18% lower adjusted odds of a post-index period relapse than patients who switched to injectable DMTs. The number of baseline relapses was not associated with persistence but with 68% higher odds of a post-index relapse, with each additional baseline relapse associated with a 44% increase in number of post-index relapses. Conclusions: Among patients with MS who switched DMTs, persistence was consistently low regardless of treatment. Although persistence with oral DMTs was slightly higher than with injectable DMTs, overall results indicate poor persistence to second-line therapy and highlight the need to improve long-term persistence with DMTs.

Retrospective Claims Analysis of Treatment Patterns, Relapse, Utilization, and Cost Among Patients with Multiple Sclerosis Initiating Second-Line Disease-Modifying Therapy

“…Several studies have examined recent real-world treatment patterns, HCRU, and cost among patients with MS treated with DMTs [1,15,[17][18][19]. Given the speed at which the treatment landscape is evolving [20], it is important that we evaluate treatment patterns with the most current DMTs.…”

“…Initial choice of treatment and subsequent treatment modifications are often driven by the risk of disease progression. Escalation—an approach to therapy that begins with less potent and relatively safer DMTs—is most often used for patients with MS [ 2 , 15 , 16 ]. Switches between DMTs are considered after breakthrough disease activity (evidence of continued relapses or activity on magnetic resonance imaging).…”

“…Given the speed at which the treatment landscape is evolving [ 20 ], it is important that we evaluate treatment patterns with the most current DMTs. Furthermore, there is a need to clarify the experience of patients who have switched to a second DMT [ 15 ]. Currently, few studies have examined the real-world use of second-line DMTs.…”

Long-Term Efficacy Outcomes of Natalizumab vs. Fingolimod in Patients With Highly Active Relapsing-Remitting Multiple Sclerosis: Real-World Data From a Multiple Sclerosis Reference Center

“…Early switch from first- to second-line DMTs in patients with highly active RRMS has been advocated as a strategy associated with favorable disease outcomes ( 30 ). Moreover, remaining free of relapse following the switch has been linked with improved persistence to the DMT ( 31 ), a factor also contributing to favorable overall disease prognosis. Natalizumab and FTY are highly effective DMTs in reducing relapse and radiological activity ( 1 , 2 ).…”

Real-world propensity score comparison of treatment effectiveness of peginterferon beta-1a vs. subcutaneous interferon beta-1a, glatiramer acetate, and teriflunomide in patients with relapsing-remitting multiple sclerosis

“…(Cohen et al, 2020). The MarketScan Commercial claims database, used herein, represents a high-quality data source, is considered reliable for capturing real-world healthcare data with data quality assessments performed, and has been used in a multitude of studies, including those measuring treatment patterns and outcomes of MS patients (Boster et al, 2017;Bowen et al, 2020;Ontaneda et al, 2019;Capkun et al, 2015).…”