Wednesday, 5 August 2015

Are your CRAB drugs any good, 2/3 Germans don't think so within 2 years

Adherence to Disease Modifying Drugs among Patients with Multiple Sclerosis in Germany: A Retrospective Cohort Study.
Hansen K, Schüssel K, Kieble M, Werning J, Schulz M, Friis R, Pöhlau D, Schmitz N, Kugler J. PLoS One. 2015; 10(7):e0133279. doi: 10.1371/journal.pone.0133279. eCollection 2015.


BACKGROUND:Long-term therapies such as disease modifying therapy for Multiple Sclerosis (MS) demand high levels of medication adherence in order to reach acceptable outcomes. The objective of this study was to describe adherence to four disease modifying drugs (DMDs) among statutorily insured patients within two years following treatment initiation. These drugs were interferon beta-1a i.m. (Avonex), interferon beta-1a s.c. (Rebif), interferon beta-1b s.c. (Betaferon) and glatiramer acetate s.c. (Copaxone).
METHODS:This retrospective cohort study used pharmacy claims data from the data warehouse of the German Institute for Drug Use Evaluation (DAPI) from 2001 through 2009. New or renewed DMD prescriptions in the years 2002 to 2006 were identified and adherence was estimated during 730 days of follow-up by analyzing the medication possession ratio (MPR) as proxy for compliance and persistence defined as number of days from initiation of DMD therapy until discontinuation or interruption.
FINDINGS:A total of 52,516 medication profiles or therapy cycles (11,891 Avonex, 14,060 Betaferon, 12,353 Copaxone and 14,212 Rebif) from 50,057 patients were included into the analysis. Among the 4 cohorts, no clinically relevant differences were found in available covariates. The Medication Possession Ratio (MPR) measured overall compliance, which was 39.9% with a threshold MPR≥0.8. There were small differences in the proportion of therapy cycles during which a patient was compliant for the following medications: Avonex (42.8%), Betaferon (40.6%), Rebif (39.2%), and Copaxone (37%). Overall persistence was 32.3% at the end of the 24 months observation period, i.e. during only one third of all included therapy cycles patients did not discontinue or interrupt DMD therapy. There were also small differences in the proportion of therapy cycles during which a patient was persistent as follows: Avonex (34.2%), Betaferon (33.4%), Rebif (31.7%) and Copaxone (29.8%).
CONCLUSIONS:Two years after initiating MS-modifying therapy, only 30-40% of patients were adherent to DMDs

This study examined who was taking their drugs after 2 years and about 60% of this German cohort of people had given up on their drugs and this will be because of side-effects, lack of convenience or lack of efficacy.

25 comments:

  1. CRAB = copaxone rebif avonex betaferon but why choose CRAB. This is an industry term apparently used by the marketeers. Said in some ways the B sounds like a P, is that an in-joke? In this study as most people have switched in 2 years they are not happy

    Maybe CARB sounds to too fattening, BARC means they are the dogs *ollocks and a better sale point but should we have CRAAB or is it CARAB/BARAC for low efficacy drugs.

    In the words of Harry Enfield I guess CRAB means "loads a money" as the crustacean is a bit expensive

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    1. To me it sounds like an STD, not that I've had it;)

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  2. I think we need new guidelines for neuros saying that highly effective treatments should be prescribed first and CRABs in only exceptional circumstances. If I need new brakes for my car I don't opt for the ones that are 30 per cent effective, but the best on the market i.e i want to provide the best protection for myself and my family. Neuros should be ashamed for prescribing ineffective drugs when better ones are available.

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    1. The point is: a more effective more undesirable side effects.

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    2. Given the fact that just yesterday the FDA issued a PML warning for the "highly effective" drug Fingolomod, I'll stick to my CRAB:

      http://www.fda.gov/Drugs/DrugSafety/ucm456919.htm

      Given the mode of action of these new drugs, it should be no surprise the is an effect. Pharma and the G-like neuros are using MSers as guinea pigs to evaluate the long term effects of these new therapies.

      Hopefully the victims can pursue prosecution as a result to hopefully stop this strategy because as it is now the drug approval process is broken.

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    3. "Given the fact that just yesterday the FDA issued a PML warning for the "highly effective" drug Fingolomod, I'll stick to my CRAB"
      That is of course, your choice. Everyone needs to be made aware of the potential risks of the new more effective DMTs so they can make their own risk/benefit decision.

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    4. "Everyone needs to be made aware of the potential risks of the new more effective DMTs so they can make their own risk/benefit decision."

      The problem with the new DMD's is that the risks are not known until several years after the introduction into the market.

      As it is know, you have to rely on your doctor to be aware of issues except for the case with Tysabri which took many lives before controls were implemented.

      If you have a Doctor that graduated the last in his class or has no clue about what he is doing this is a recipe for disaster.

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    5. "The problem with the new DMD's is that the risks are not known until several years after the introduction into the market."
      Which is why it's so important to keep monitoring those who are treated beyond the time frame of the initial trial. You don't have to rely on your doctor, all the information is out there these days, which is a good thing. If you have a duff doctor, you are free to change to another, should you so wish.

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    6. I agree in an ideal world, patients should be up to date about what is going on. However I think there are a lot of people who just trust the judgement of their doctors.

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    7. "You don't have to rely on your doctor, all the information is out there these days, which is a good thing. "

      Ah yes, this is what I currently dislike. Getting an opinion from my neurologist is like getting blood out of a stone. Yes, lots of information out there and that is a good thing, but sometimes it would be nice to know what he/she thinks too. It has got to be a 'partnership' arrangement where the neurologist (who has the expertise, experience and knowledge far greater than me) guides and advises, surely?

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    8. A doctor who graduated last in his class is unlikely to end up as a consultant neurologist. If you have very active MS are you going to go with the proabability you will be in a wheelchair in 10 years or the possibility of a side effect from one of the more effective DMDs? It's the risk;benefit ratio again and what you are willing to accept. I don't think there has been a case of PML with alemtuzumab when used for MS as far as I'm aware.

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    9. Most people with MS don't have highly active disease despite what team G wants you to believe. I agree the CRAB drugs are not effective for these minority of patients but for most they are a good choice. Failure to adhere to a treatment does not mean the treatment is a failure, but this is what Team G would like you to conclude from this post.

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    10. But what's going on beneath the surface in those who don't have highly active disease?
      I think failure to adhere to a treatment speaks for itself IMO.

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    11. I had highly active disease, in and out of hospital at onset. A few years later I changed hospital, saw a new neurologist who told me I had benign MS. This wasn't because I'd been monitored with MRI scans they weren't around, it was judging a book by it's cover. I've never had DMTs, so that's not the explanation.

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    12. No disrespect but I'm wondering why some neurologists still say benign MS. Does it really exist? It seems to me there are two neurology camps, neurologists that don't believe it exists and those that do. It would be great if there was a consensus on this as it bloody confusing for people with MS, when some neurologists say it's benign and some say you have active disease!

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    13. There are still neurologists yet to get with the program. It is simply unacceptable that the wait and see and hope for the best approach is still being used by some.

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    14. And that is the problem MD2, who do patients believe and why is there no consensus? I've been told I had benign MS, then active MS, then benign MS again and currently back to active MS. To avoid complete cognitive dissonance, I'm on a DMD but really this is crazy-making stuff. Is there really know way of 'forcing' a consensus?

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    15. believe me, forcing any sort of consensus on neurologists (who seem to be a breed apart when it comes to this) makes herding cats a breeze by comparison, though I think things are changing (but at a glacial pace).

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    16. But Mousedoctor2 I was the reverse, it looked benign because my new neurologist had not seen me at my worst. MS is unpredictable which is why no doctor can guarantee efficacy.

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    17. Ugh, I've never tried herding cats but I see what you mean. Unfortunately the neurologists who believe in benign MS are unlikely to visit this blog but if they do, my message is 'get your act together, it's not your brain at risk!'

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    18. For a little light relief, herding cats is possible ;-)
      https://www.youtube.com/watch?v=Pk7yqlTMvp8

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    19. Have, well if nothing else it will increase you unique visitors by mentioning cats as a keyword;)

      PS: cute cats, funny cats, unusual cats, Dr cats, uncool Dr cats

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    20. Ah yes, our Cats and MS post was one of our most popular ever! ;-)

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  3. I would like every patient to have their choice; red pill or blue pill: CRAB or highly effective. I am happy on Tysabri because I know that it is effective and the risks are managed.

    We learn as we progress, but we have to make the best decision with the knowledge available today.

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  4. If an MSer had highly active MS and I was a neurologist I would investigate into if the MSer was suffering from the following: stress, anxiety, frequent infections as these are all relapse triggers.

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