Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study
Compliance to fingolimod and other disease modifying treatments in multiple sclerosis patients, a retrospective cohort study
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DOI：
10.1186/1471-2377-13-138
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发表时间：
2013-10-04
期刊：
影响因子：
2.6
通讯作者：
Brandes, David W.
中科院分区：
文献类型：
--
作者：
Agashivala, Neetu;Wu, Ning;Brandes, David W.
背景资料：坚持疾病修饰疗法（DMT）可减少复发的数量和严重程度，并延迟多发性硬化症（MS）的进展。依从率较低的患者会经历更多的住院治疗和更高的MS相关医疗费用。Fingolimod是美国食品和药物管理局批准的第一种口服DMT，与注射用DMT相比，可以改善MS治疗的可及性和依从性。2010年10月至2011年2月期间开始DMT的患者。启动定义为在过去12个月内未使用相同DMT的处方药。在索引日期前12个月未填写DMT处方的患者被视为首次使用者。依从性通过指数后12个月的覆盖天数比例（PDC）和药物拥有率（MPR）来衡量。停药定义为指标DMT供应缺口>= 60天。结果：在1，891例MS患者（平均年龄：45.7岁;女性：76.4%）中，13.1%开始使用芬戈莫德，10.7%开始使用干扰素β-1b，20.0%开始使用肌内干扰素β-1a，18.8%开始使用皮下干扰素β-1a，37.4%开始使用醋酸格拉替雷。开始芬戈莫德治疗的患者在有经验的DMT使用者（芬戈莫德：平均PDC=0.83，73.7%的患者PDC >= 0.8;平均MPR=0.92，90.5%的患者MPR >= 0.8）和初次DMT使用者（芬戈莫德：平均PDC=0.80，66.7%的患者PDC >= 0.8;平均MPR=0.90，87.4%的患者MPR >= 0.8）中的平均PDC和MPR最高。芬戈莫德队列中12个月内停用指标DMT的患者比例显著较低（初治：31.3%;有经验：25.7%）。调整后的结果发现，接受自我注射DMT的患者比fingolimod使用者更快地停止治疗。这种关联一般是在有经验的DMTusers.Conclusions强：芬戈莫德启动者更符合，不太可能停止治疗，并停止晚于患者谁开始自我注射DMT。
Background: Adherence to disease-modifying therapies (DMTs) results in the reduction of the number and severity of relapses and delays the progression of multiple sclerosis (MS). Patients with lower adherence rates experience more inpatient visits and higher MS-related medical costs. Fingolimod, the first oral DMT approved by the US Food and Drug Administration, may improve the access and compliance to MS treatment when compared to injectable DMTs.Methods: This retrospective cohort study used pharmacy claims from Medco Health Solutions, Inc., of patients who initiated DMTs between October 2010 and February 2011. Initiation was defined as no prescription fills for the same DMT in the prior 12 months. Patients without a DMT prescription fill 12 months before the index date were considered naive users. Compliance was measured via proportion of days covered (PDC) and medication possession ratio (MPR) for 12 months post-index. Discontinuation was defined as a >= 60-day gap of index DMT supply. Cox proportional hazard models compared time to discontinuation between cohorts.Results: Of 1,891 MS patients (mean age: 45.7; female: 76.4%), 13.1% initiated fingolimod, 10.7% interferon beta-1b, 20.0% intramuscular interferon beta-1a, 18.8% subcutaneous interferon beta-1a, and 37.4% glatiramer acetate. Patients initiating fingolimod had highest average PDC and MPR in both experienced (fingolimod: mean PDC=0.83, 73.7% with PDC >= 0.8; mean MPR=0.92, 90.5% with MPR >= 0.8) and naive DMT users (fingolimod: mean PDC=0.80, 66.7% with PDC >= 0.8; mean MPR=0.90, 87.4% with MPR >= 0.8). The proportion of patients discontinuing index DMT within 12 months was significantly lower for the fingolimod cohort (naive: 31.3%; experienced: 25.7%). Adjusted results found that patients receiving self-injected DMTs discontinued significantly sooner than fingolimod users. This association was generally stronger in experienced DMT users.Conclusions: Fingolimod initiators were more compliant, less likely to discontinue treatment, and discontinued later than patients who initiated self-injected DMT.