Improved Persistence Observed Among Patients With MS Starting Oral DMTs

Fingolimod and teriflunomide were associated with better persistence and adherence at 6 and 12 months than dimethyl fumarate or diroximel fumarate in patients with multiple sclerosis (MS) starting oral disease-modifying therapies (DMTs), according to study findings published in Neurology and Therapy.

“Patients newly initiated on the fumarates (dimethyl fumarate and diroximel fumarate) had a larger percentage of patients switching and a shorter time to switching to a higher-cost therapy than patients newly initiated on the other oral DMTs,” wrote researchers from Sanofi.

The retrospective study analyzed health record data for 6934 patients in the United States who started 1of 4 oral DMTs (teriflunomide, dimethyl fumarate, fingolimod, or diroximel fumarate) during the first half of 2020.

Rates of treatment persistence at 12 months were 66% with fingolimod, 60% with teriflunomide, 49% with diroximel fumarate, and 44% with dimethyl fumarate, according to study findings. Rates of adherence, defined as medication possession ratio of at least 80%, at 6 months were 76% with fingolimod, 71% with teriflunomide, 60% with dimethyl fumarate, and 58% with diroximel fumarate. Adherence rates at 12 months were 59% with fingolimod, 55% with teriflunomide, 44% with diroximel fumarate, and 40% with dimethyl fumarate.

The highest rate of switching to a more expensive treatment (ocrelizumab, natalizumab, or cladribine) occurred with dimethyl fumarate (7%), followed by diroximel fumarate (6%). Rates of switching with fingolimod and teriflunomide were 5% each, study authors found.

Patients who switched to a higher-cost treatment did so after approximately 8 months.

“Increased medication persistence and adherence are important factors in achieving therapeutic goals in MS, and their clinical and economic benefits are well documented,” wrote researchers. “Our findings can inform and support improved treatment-related decision-making among patients and providers.”

Reference:
Araujo L, Geertsen SS, Amedume A, Higuchi K, van Wingerden J. Persistence, adherence, and switching to higher-cost therapy in patients with multiple sclerosis initiating oral disease-modifying therapies: a retrospective real-world study. Neurol Ther. Published online September 24, 2022. doi: 10.1007/s40120-022-00404-1