Contributions
Abstract: P698
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Background: In Switzerland, fingolimod has been approved as a first-line treatment in patients with relapsing-remitting multiple sclerosis (MS). In 2013, the Community Pharmacy of the Department of Ambulatory Care & Community Medicine in Lausanne implemented a person-centred integrated care programme for optimising safety and effectiveness of fingolimod. This routine pharmacist-led programme is proposed to each consecutive patient starting fingolimod at the local University hospital (Centre Hospitalier Universitaire Vaudois, CHUV). It combines motivational interviews, adherence monitoring with an electronic monitor (EM), risk evaluation & mitigation strategies (REMS) and a collaborative practice with the neurologist and the MS-nurse.
Objectives: To describe adherence (persistence and implementation) to fingolimod of patients taking part in the person-centred integrated care programme.
Methods: EM data of each patient who took part in the programme since 2013 were analysed and reconciled with the pill count and interview notes. Adherence was characterized by two operational concepts: persistence and implementation. Persistence to fingolimod was defined as the length of time from initiation to “discontinuation” and estimated by a Kaplan-Meier curve. We compared two definitions of discontinuation: 1) as an interruption of fingolimod prompted by the patient alone, 2) as any interruption of fingolimod (decided alone or in collaboration with the physician). Implementation was computed at each day D as the proportion of patients taking fingolimod as prescribed, among patients still persistent at day D. A logistic Generalized Estimating Equation model was used to estimate implementation over time.
Results: EM data of 40 patients (all were naive of fingolimod and 25 of any MS treatment), median age 33.5 years old [IQR: 27.0; 42.3], 23 women (58%), were analyzed. Median follow-up was 376 days [IQR: 207.5; 577.5]. The 1-year persistence of patients discontinuing fingolimod based on their own decision was 95%, and 88% when considering the physician"s decision as well. Implementation decreased over time during about 7 months (nadir at 85%). The tendency is reversed during the second part of the year (quadratic model).
Conclusions: The 1-year fingolimod implementation and persistence in patients taking part in a person-centred integrated care programme were high. This on-going programme will provide data over longer periods of time with more patients for future analysis.
Disclosure:
M. Schluep has served as a consultant for Merck-Serono, has received honoraria, payment for development of educational presentations and travel support from Biogen, Genzyme, Merck-Serono, Novartis, Roche and Sanofi-Aventis.
A. Bourdin, M. Schneider, I. Locatelli, J. Berger and O. Bugnon have nothing to disclose.
The development of the patients" programme was supported by an unrestricted grant from Novartis Pharma Schweiz AG.
Abstract: P698
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Background: In Switzerland, fingolimod has been approved as a first-line treatment in patients with relapsing-remitting multiple sclerosis (MS). In 2013, the Community Pharmacy of the Department of Ambulatory Care & Community Medicine in Lausanne implemented a person-centred integrated care programme for optimising safety and effectiveness of fingolimod. This routine pharmacist-led programme is proposed to each consecutive patient starting fingolimod at the local University hospital (Centre Hospitalier Universitaire Vaudois, CHUV). It combines motivational interviews, adherence monitoring with an electronic monitor (EM), risk evaluation & mitigation strategies (REMS) and a collaborative practice with the neurologist and the MS-nurse.
Objectives: To describe adherence (persistence and implementation) to fingolimod of patients taking part in the person-centred integrated care programme.
Methods: EM data of each patient who took part in the programme since 2013 were analysed and reconciled with the pill count and interview notes. Adherence was characterized by two operational concepts: persistence and implementation. Persistence to fingolimod was defined as the length of time from initiation to “discontinuation” and estimated by a Kaplan-Meier curve. We compared two definitions of discontinuation: 1) as an interruption of fingolimod prompted by the patient alone, 2) as any interruption of fingolimod (decided alone or in collaboration with the physician). Implementation was computed at each day D as the proportion of patients taking fingolimod as prescribed, among patients still persistent at day D. A logistic Generalized Estimating Equation model was used to estimate implementation over time.
Results: EM data of 40 patients (all were naive of fingolimod and 25 of any MS treatment), median age 33.5 years old [IQR: 27.0; 42.3], 23 women (58%), were analyzed. Median follow-up was 376 days [IQR: 207.5; 577.5]. The 1-year persistence of patients discontinuing fingolimod based on their own decision was 95%, and 88% when considering the physician"s decision as well. Implementation decreased over time during about 7 months (nadir at 85%). The tendency is reversed during the second part of the year (quadratic model).
Conclusions: The 1-year fingolimod implementation and persistence in patients taking part in a person-centred integrated care programme were high. This on-going programme will provide data over longer periods of time with more patients for future analysis.
Disclosure:
M. Schluep has served as a consultant for Merck-Serono, has received honoraria, payment for development of educational presentations and travel support from Biogen, Genzyme, Merck-Serono, Novartis, Roche and Sanofi-Aventis.
A. Bourdin, M. Schneider, I. Locatelli, J. Berger and O. Bugnon have nothing to disclose.
The development of the patients" programme was supported by an unrestricted grant from Novartis Pharma Schweiz AG.