An estimated 240000 people in Germany are living with relapsing multiple sclerosis (RMS), which substantially impacts quality of life. Injectable, infusion and oral disease-modifying therapies (DMTs) are available for treatment; some of the most commonly used first-line DMTs in Germany are glatiramer acetate (GA) including follow-on GA (FOGA), dimethyl fumarate (DMF) and teriflunomide (TER). Little is known about current comparative patient characteristics and outcomes associated with injectable or oral DMTs in the real world.
Describe patient demographics, clinical characteristics and treatment patterns (switching/discontinuation) among RMS patients on commonly prescribed DMTs.
This was a retrospective claims database analysis using data from the Institute for Applied Health Research Berlin database. International Classification of Diseases and Anatomical Therapeutic Chemical Classification system codes were used to identify RMS patients, in the index period 1 Jan 2016 to 31 Dec 2018. Patients were eligible if they had: ≥1 inpatient RMS diagnosis and/or ≥2 outpatient or ≥1 outpatient diagnosis and a DMT prescription in the enrolment period. Patients were naïve for the respective DMT, defined by a 12-month prescription-free period (pre-initiation).
Of 16283 patients with RMS; 1577 patients met all inclusion criteria (GA, n=575; FOGA, n=24; DMF, n=608; TER, n=370). The FOGA group was too small for further analyses. Patients in the TER group were older and had a higher proportion of comorbid hypertension, depression and antidepressant use versus other groups. No other substantial demographic differences were observed. Pre-index mean (standard deviation [SD]) annual overall relapse rate (ORR) was 1.18 (1.19) for GA, 1.18 (1.20) for DMF and 0.99 (1.28) for TER; post-index mean (SD) ORR (12 months post-initiation) was 1.05 (1.56) for GA, 1.00 (1.53) for DMF and 0.86 (1.43) TER. 12 months post-initiation, DMT persistence was 45.9% for GA, 49.7% for DMF and 54.6% for TER; switch rates were 21.0% for GA, 17.4% for DMF and 14.1% for TER.
RMS patients prescribed GA and DMF were generally comparable in demographics, measures of disease activity, and treatment persistence. Despite different administration methods and mechanisms of action, similar ORR and treatment persistence were observed. In contrast, patients prescribed TER were numerically older and exhibited more comorbidities and lower pre-/post-treatment ORR.