A systematic review of real-world adherence and persistence of once- or twice-daily oral disease-modifying drugs (dimethyl fumarate, fingolimod, and teriflunomide) in multiple sclerosis
Author(s): ,
J. Nicholas
Affiliations:
OhioHealth Multiple Sclerosis Center, Columbus, OH
,
N. Edwards
Affiliations:
Health Services Consulting Corporation, Boxborough, MA, United States
,
R. Edwards
Affiliations:
Health Services Consulting Corporation, Boxborough, MA, United States
,
A. Dellarole
Affiliations:
Fair Dynamics Consulting, Milan, Italy
,
M. Grosso
Affiliations:
EMD Serono, Inc., Rockland, MA, United States
A. Phillips
Affiliations:
EMD Serono, Inc., Rockland, MA, United States
ECTRIMS Online Library. Nicholas J. Oct 12, 2018; 229105; P1265
Jacqueline Nicholas
Jacqueline Nicholas
Contributions
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Abstract

Abstract: P1265

Type: Poster Sessions

Abstract Category: Therapy - Tools for detecting therapeutic response

Objective: To assess the availability and variability of reported once- or twice-daily oral disease-modifying drugs (DMDs; ie, dimethyl fumarate, fingolimod, and teriflunomide) adherence and/or persistence across real-world data sources in patients with multiple sclerosis (MS).
Methods: A systematic literature review of studies published between January 2010-April 2018 evaluating adherence and/or persistence with once- or twice-daily oral DMDs was performed. The PubMed search strategy was: (Aubagio OR dimethyl fumarate OR fingolimod OR Gilenya OR Tecfidera OR teriflunomide OR oral OR disease modifying drug OR DMD OR disease modifying therapy OR DMT) AND multiple sclerosis AND (adherence OR compliance OR persistence OR discontinuation). A priori exclusion criteria were: no primary data (narrative and systematic reviews, meta-analyses, editorials, or study design reports excluded); no real-world DMD adherence/persistence data; oral DMD adherence/persistence not reported; pediatric studies; non-English studies; and abstract only available. Two screeners independently reviewed search results and reference lists of selected articles. A third individual adjudicated disagreements. Data extraction was also conducted in this manner.
Results: From 510 potentially relevant citations, 31 studies comprising 16,398 patients were included in the systematic review after applying exclusion criteria. The origin of the studies was the US (58.1%; n=18), Europe (25.8%; n=8), Global (6.5%; n=2), Canada (6.5%; n=2); and Kuwait (3.2%; n=1). The data sources were retrospective chart/electronic medical record (38.7%; n=12); prospective observational cohort (22.6%; n=7); administrative claims database (25.8%; n=8); patient registry (9.7%; n=3); and patient survey (3.2%; n=1). Duration of follow-up ranged from 3 months to 3 years, with 21 studies (67.7%) reporting 1-year data. All 31 studies evaluated treatment discontinuation (1-year discontinuation range 5.1%-42.3%; 21 studies). One-year adherence was reported in 4 studies with the mean medication possession ratio (MPR) range 0.68-0.91, 6 studies with MPR ≥80% range 53.0%-93.8%, 4 studies with the mean proportion of days covered (PDC) range 0.72-0.82, and 5 studies with PDC ≥80% range 61.4%-89.7%.
Conclusions: This assessment of real-world studies highlighted that a significant number of patients with MS do not adhere to once- or twice-daily oral DMDs and early discontinuation of these treatments is suboptimal for patients with MS.
Disclosure: JN has received consulting fees for speaking, advising and consulting from: Biogen Idec, EMD Serono, Genzyme, Genentech, MSAA, MS World and Novartis. She has received research grants from Genzyme, Biogen and Novartis. NCE and RAE are employees of Health Services Consulting Corporation. AD is an employee of Fair Dynamics Consulting and worked on behalf of Health Services Consulting Corporation. Health Services Consulting Corporation received funding from EMD Serono, Inc.* to run the analysis. MG and ALP are employees of EMD Serono, Inc., Rockland, MA, USA.
*A business of Merck KGaA, Darmstadt, Germany.

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