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Disease modifying treatments (DMTs) in Germany - changes in treatment patterns
Author(s): ,
A. Stahmann
Affiliations:
MS-Register, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover
,
F. Fneish
Affiliations:
MS-Register, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover
,
K. Eichstädt
Affiliations:
MS-Register, MS Forschungs- und Projektentwicklungs-gGmbH, Hannover
,
P. Flachenecker
Affiliations:
Neurological Rehabilitation Center Quellenhof, Bad Wildbad
,
T. Friede
Affiliations:
Department of Medical Statistics, University Medical Center Göttingen, Georg August University Göttingen, Göttingen
,
J. Haas
Affiliations:
MS-Center, Jewish Hospital Berlin, Berlin; German MS Society, Hannover
,
C. Kleinschnitz
Affiliations:
Department of Neurology, University Hospital Essen, Essen
,
D. Pöhlau
Affiliations:
German MS Society, Hannover; Department of Neurology, German Red Cross - Kamillus-Clinic, Asbach
,
O. Rienhoff
Affiliations:
Department of Medical Informatics, University Medical Center Göttingen, Georg August University Göttingen, Göttingen
,
P.S. Rommer
Affiliations:
Department of Neurology, University of Rostock, Rostock, Germany; Department of Neurology, Medical University of Vienna, Vienna, Austria
,
U.K. Zettl
Affiliations:
Department of Neurology, University of Rostock, Rostock, Germany
for the German Multiple Sclerosis Register of the German National MS Society [DMSG]
for the German Multiple Sclerosis Register of the German National MS Society [DMSG]
Affiliations:
ECTRIMS Online Library. Stahmann A. Oct 10, 2018; 229438; EP1601
Alexander Stahmann
Alexander Stahmann
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Abstract: EP1601

Type: Poster Sessions

Abstract Category: Therapy - Immunomodulation/Immunosuppression

Background: The German MS-Register, initiated in 2001 by the German MS society (DMSG), has undergone a major technical revision between 2014 and 2016. Detailed information on disease-modifying drug treatment for multiple periods per patient is now collected.
Objective: To provide insights how the availability of new treatment options changed treatment patterns.
Methods: For a subset of patients (relapsing-remitting MS, receiving DMT treatment in their last visit, detailed information on DMT available, N=4,239) historical and current DMTs where exported from the database. Patients were attributed to one of the following three groups according to DMT starting date: 1) before 2006 [N=794], 2) after 2006 but before 2011 [N=1,482] and 3) beginning in 2011 [N=1,963]. The dates where chosen based on the emergence of major new treatment options after market authorization.
Results: For the 1st group the most frequently used initial DMTs were interferons (IFN) (76.9%), followed by glatirameracetate (GLAT) (15.9%), azathioprine (AZA) (3.9%) and others (3.1%). Secondary treatment option were mostly (other) IFN (28.2%) followed by GLAT (13.6%), natalizumab (NAT) (10.7%), fingolimod (FYD) (7.5%) and others. 25% patients with initial DMT before 2006 are either still on the initial DMT or have discontinued the treatment.
In the 2nd group initial DMTs were still primarily IFN (67.2%) and GLAT (24.1%). NAT was used as first line treatment in 4.4% of patients. Secondary treatments for the 2nd group were mostly IFNs (22.7%) followed by FYD (12.2%), GLAT (11.9%) and NAT (11.4%). 24.9% are either still on the initial DMT or have discontinued the treatment.
In the 3rd group initial DMTs were again mostly IFNs (68.7%) followed by GLAT (22.8%) and NAT (3.4%). Secondary treatment option were in the majority of cases IFNs (21.8%) followed by FYD (11.5%), GLAT (10.9%), NAT (10.1%) and dimethyl fumarate (DMF) (6.2%). 28.7% of the patients in this group are either still on the initial DMT or have discontinued the treatment.
Conclusion: The availability of new treatment options significantly changed the prescription patterns in Germany. Our analysis showed that in line with the guidelines most patients are initially treated with IFN or GLAT. Depending on the duration since initial DMT start secondary DMTs differed quite a lot. Interestingly, throughout all three groups, a substantial proportion of patients (approximately 25%) did not switch treatment.
Disclosure:

  • Peter Flachenecker has received speaker's fees and honoraria for advisory boards from Almirall, Bayer, Biogen, Genzyme, Merck-Serono, Novartis, Roche and Teva. He has participated in pharmaceutical company sponsored trials by Almirall, Biogen Idec and Novartis. None resulted in a conflict of interest.
  • Tim Friede has received personal fees for consultancies (including data monitoring committees) in the past three years from Bayer, Boehringer Ingelheim, DaiichiSankyo, Feldmann Patent Attorneys, Galapagos, Grünenthal, Janssen, Mediconomics, Novartis, Penumbra, Pharmalog, Roche, SGS, UCB; all outside the submitted work.
  • Judith Haas has received compensation from Almirall, Allergan, Biogen, Bayer, HOFFMANN La Roche, Merck, Novartis, Octapharma and Teva.
  • Christoph Kleinschnitz has received personal compensations for giving lectures and attending advisory boards from Biogen, Merck Serono, Bayer, Teva, Novartis, Medday, Mylan, Genzyme, Almirall, and Roche.
  • Dieter Pöhlau received institutional research grants and personal honoraria as speaker from Almirall, Biogen Idec, Bayer, Genzyme, Merck Serono, Novartis, Sanofi and TEVA.
  • Paulus S.Rommer received institutional research grants and personal honoraria as speaker from Biogen Idec, Merck Serono, Roche. Received personal honoraria as speaker or for consultancy from Biogen Idec, Merck Serono, Roche, Sanofi, Shire and TEVA.
  • Uwe K. Zettl received institutional research grants and personal honoraria as speaker from Almirall, Biogen Idec, Bayer, Merck Serono, Novartis, Roche, Sanofi and TEVA.
  • Kerstin Eichstädt, Firas Fneish, Otto Rienhoff and Alexander Stahmann have nothing to disclose.
The German MS-Register,is a project of the German MS Society. It is supported by the German MS Society's Trust and the MS Society itself.

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