Bristol-Myers Squibb Company

Author Of 2 Presentations

Observational Studies Poster Presentation

P0927 - Treatment discontinuation and restart among patients with multiple sclerosis using disease-modifying therapies (ID 699)

Speakers
Presentation Number
P0927
Presentation Topic
Observational Studies

Abstract

Background

Patients with multiple sclerosis (MS) change and discontinue disease-modifying therapies (DMTs) for a variety of reasons. Relatively little is known about the dynamics of these changes across different DMTs.

Objectives

This objective of this study examined patterns of DMT change, discontinuation, and restart in patients with newly diagnosed MS.

Methods

Adults with newly diagnosed MS were identified in the IBM MarketScan Commercial and Medicare databases. Eligible patients had ≥12 months of continuous enrollment prior to their initial MS diagnosis and ≥2 years of follow-up from January 2007 to October 2017. Patients with evidence of pregnancy or any malignancy during the study period were excluded. Up to 3 courses of DMTs were reported during a follow-up period of 2 to 10.5 years. Discontinuation was defined as having a gap in therapy of ≥60 days. Restarting was defined as reinitiating the same DMT after a 60-day gap.

Results

In total, 14,627 newly diagnosed MS patients were treated with DMTs and had ≥2 years of follow-up. Of these, 25% had 2 DMT courses and 27% had 3 DMT courses during follow-up. Half of treated patients discontinued their first DMT course, but 52% of those who discontinued their first course restarted the same DMT for their second course. Mean time to restart was 165 days (median: 93 days). Patients taking glatiramer acetate (GA) and interferon beta-1b (IFN β-1b) had the highest rates of discontinuation during the first DMT course (52% and 55%, respectively) and the highest rates of restart among those who discontinued (57% and 56%, respectively). Of all patients who discontinued, those taking oral DMTs (dimethyl fumarate, fingolimod, and teriflunomide) had discontinuation rates of 43%–50% and restart rates of 31%–38%. Natalizumab had the lowest rate of discontinuation (37%) and restart (20%). Among the 7,510 patients with any second treatment course, the overall discontinuation rate increased to 56% and the rate of those who restarted their second DMT as their third course increased to 56%. Similarly, GA and IFN β-1b had the highest discontinuation and restart rates among those with a second course.

Conclusions

Over 2 to 10.5 years of follow-up, treatment discontinuation and extended treatment gaps occurred frequently among DMT-treated patients with MS. Returning to the same DMT was surprisingly common.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1067 - Understanding the patient and clinician perspective of ideal treatments for multiple sclerosis via group concept mapping (ID 698)

Speakers
Presentation Number
P1067
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Patients with multiple sclerosis (MS) have an array of treatment options targeting various aspects of their disease. Clinicians should consider patient preferences when selecting from these options. The medical literature has shown that MS patients often focus on safety as the most important attribute of a medication; however, preference instruments often include preselected attributes chosen by the investigator.

Objectives

A novel online method to elicit patient-centered preferences, Group Concept Mapping (GCM), was used to generate statements defining the patient experience in relapsing-remitting MS to identify the most important, relevant, and patient-focused outcomes from patient and clinician perspectives.

Methods

Twenty patients and 14 MS specialists in the US provided statements describing an ideal treatment that would affect daily function in MS. The statements were harmonized by the research team, sorted into domains that were meaningful to participants, and rated on importance on an 11-point scale.

Results

Sixty-four unique concepts were generated by patients and clinicians. GCM analysis identified 6 domains of clustered concepts. Patient and clinician ratings were highly correlated (r=0.82); however, patients rated items within the domains of Activities of Daily Living, Prevent & Cure, and Address Symptoms as highest in importance, while clinicians rated items within Prevent & Cure, Safe & Effective, and Activities of Daily Living as highest in importance. Three of the 11 statements in the Activities of Daily Living domain were rated above the mean in importance by both patients and clinicians; these included “improve cognitive function” and “improve motor function.” The 5 statements in the Address Symptoms domain were all rated above the mean in importance by both patients and clinicians; these included “help with memory issues” and “help preserve cognition.” The statement “improve short term memory” was 1 of 3 statements rated above the mean by patients that was rated below the mean by clinicians.

Conclusions

A high level of agreement of concept importance was found between patients and MS specialists. Both tended to rate concepts relating to cognitive function more highly than the other statements. Concepts related to safety or administration of medication were not rated as highly as concepts related to activities of daily living that have more of a functional impact on quality of life.

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