Impact of age on treatment decisions and adherence to therapy in patients with relapsing-remitting multiple sclerosis
ECTRIMS Online Library. Sørensen P. Sep 13, 2019; 278583; P1382
Prof. Per Soelberg Sørensen
Contributions Biography
Abstract

Abstract: P1382

Type: Poster Sessions

Abstract Category: Therapy - Long-term treatment monitoring

P.S. Sorensen1, H. Joensen2, F. Sellebjerg1, M. Magyari1,2

1Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen, Rigshospitalet, 2The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

Background: The average age of multiple sclerosis (MS) patients has been increasing, mainly because of increasing longevity but also because of later age at disease onset. Higher age is associated with quantitative and functional changes in the innate and adaptive immune system, and an age dependent reduction in efficacy of disease modifying therapies (DMTs). Hence, age may impact the choice of DMTs
Methods: We studied all 10,373 Danish patients who had started DMT and looked for differences in the initial treatment choice, adherence to the initial treatment and the current treatment in patients below and above the age of 40 years. Particularly, we studied the subgroup of 2,610 patients who had started the first DMT after January 1st, 2014 when oral treatments had become available.
Results: Overall, teriflunomide was the initial treatment significantly more frequently in patients above the age of 40 years at treatment start (p< 0.0001), whereas dimethyl fumarate (DMF) more frequently was chosen as the first therapy in patients below 40 years (p< 0.0001). The highly effective (second line) DMTs natalizumab and fingolimod were more frequently used in patients below the age of 40 (p< 0.001). In the subgroup of patients with start of DMT after January 1st, 2014 teriflunomide was chosen more frequently in patients above 40 (67.3%) than below 40 years (46.4%) (p< 0.0001). Contrary, patients below the age of 40 more frequently started on DMF (20.3%) than patient above 40 years (12.2%) (p< 0.0001). A highly effective DMT was chosen in 14.1% of patients below 40 compared to only 6.0% of patients above 40 (p< 0.0001). Overall, 55% of the patients were adherent to the first DMT after an average of 28 months, and patients above 40 years showed a trend towards more adherence (61%) compared to patients below 40 years (50%) (p=0.19). Patients above 40 years were more adherent to moderately effective DMTs (p< 0.0001), but not to highly effective DMTs. Regarding the current treatment, teriflunomide was more often used in patients > 40 years (44.2%) than < 40 years (24.3%) (p< 0.0001), whereas patients < 40 years more frequently than patients > 40 years received dimethyl fumarate (18.3% vs 15.1%), natalizumab (16.6% vs 7.7%) or fingolimod (13.6% vs 7.7%) (p< 0.0001).
Conclusions: The choice of initial DMT differs according to the age of the patient. Fewer patients above 40 years started with a highly effective DMT. Adherence to moderately effective DMTs is higher in patients above 40 years.
Disclosure: P. S. Sorensen has received personal compensation for serving on scientific advisory boards, steering committees, independent data monitoring committees or have received speaker honoraria for Merck, Novartis, TEVA, GlaxoSmithKline, MedDay Pharmaceuticals, SanofiAventis/Genzyme, and Celgene. Hanna Joensen has nothing to disclose. M. Magyari has served on scientific advisory board for Biogen, Sanofi, Teva, Roche, Novartis, Merck, has received honoraria for lecturing from Biogen, Merck, Novartis, Sanofi, Genzyme, has received research support and support for congress participation from Biogen, Genzyme, Teva, Roche, Merck, Novartis. F. Sellebjerg has served on scientific advisory boards, been on the steering committees of clinical trials, served as a consultant, received support for congress participation, received speaker honoraria, or received research support for his laboratory from Biogen, Merck, Novartis, Roche, Sanofi Genzyme and Teva.

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