IBM Watson Health

Author Of 1 Presentation

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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