Research: persistence on MS therapies

#MSBlog: How will the orals affect persistence figures on MS DMTs?

Epub: Jokubaitis et al. The Australian Multiple Sclerosis (MS) Immunotherapy Study: A Prospective, Multicentre Study of Drug Utilisation Using the MSBase Platform. PLoS One. 2013;8(3):e59694. doi: 10.1371/journal.pone.0059694.

OBJECTIVE: To prospectively characterise treatment persistence and predictors of treatment discontinuation in an Australian relapsing-remitting multiple sclerosis (RRMS) population.

METHODS: Tertiary MS treatment centres participating in the MSBase registry prospectively assessed treatment utilisation, persistence, predictors of treatment discontinuation and switch rates. Multivariable survival analyses were used to compare treatment persistence between drugs and to identify predictors of treatment discontinuation.

RESULTS: 1113 RRMSers were studied. MSers persisted on their first disease-modifying therapy (DMT) for a median of 2.5 years. Treatment persistence on GA was shorter than on all IFNβ products (p<0.03). Younger age at treatment initiation and higher EDSS were predictive of DMT discontinuation. MSers persisted on subsequent DMTs, for 2.3 years. MSers receiving natalizumab (NAT) as a subsequent DMT persisted longer on treatment than those on IFNβ or GA (p<0.000). The primary reason for treatment discontinuation for any drug class was poor tolerability. Annualised switch or cessation rates were 9.5-12.5% for individual IFNβ products, 11.6% for GA and 4.4% for NAT. 

CONCLUSION: This multicentre MS cohort study is the first to directly compare treatment persistence on IFNβ and GA to NAT. The investigators' report that treatment persistence in their Australian RRMS population is short, although MSers receiving IFNβ as a first DMT persisted longer on treatment than those on GA. Additionally, MSers receiving NAT as a subsequent DMT were more likely to persist on treatment than those switched to IFNβ or GA. EDSS and age at DMT initiation were predictive of DMT discontinuation. Treatment intolerance was the principal reason for treatment cessation.

"Important take home messages are younger age and more disability predicted poor persistence with treatment. Could younger age be counteracted by more education on the severity of MS and why DMTs are prescribed  and the disability issue with agents that are better tolerated?"

"Interestingly, persistence was greater with Natalizumab, the more efficacious agent, and the agent that is associated with relatively good tolerability. Not surprised this is my experience as well."

"It will be interesting to see how the oral DMTs change the mix. I am sure persistence will improve although all the orals will have their own issues. BG12 may have a problems because of twice daily dosing, short-term tolerability issues (gastrointestinal symptoms and flushing) and low lymphocyte counts. Teriflunomide due to hair thinning, GIT symptoms and blood and liver function test abnormalities. Fingolimod due to very low lymphocyte counts and liver function abnormalities. On the face of things once you get onto fingolimod, i.e. past the first dose effect, it may be the best tolerated of the orals. I therefore predict that fingolimod will have the highest persistence figures. Time will tell."

CoI: multiple

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