Contributions
Abstract: EP1698
Type: ePoster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Introduction: Dimethyl fumarate (DMF) is an oral disease modifying therapy (DMT) licensed to treat relapsing multiple sclerosis (RMS). The rate of discontinuation due to adverse effects in the pivotal trials was 12-16%. We aimed to determine the stopping rate at Imperial College Healthcare NHS Trust (ICHNT) and the reasons for its discontinuation.
Method: Patients who discontinued DMF were identified from a local database. These patients were interviewed using a telephone questionnaire. The reasons for stopping treatment were recorded. Patients who had stopped due to side effects were asked to identify which health care professional they had contacted prior to this decision. Information on subsequent treatment choices was also obtained.
Results: ICHNT recorded 352 patients being treated with DMF. 142 (29%) patients were identified as having stopped treatment. Excluding those stopping for progression the discontinuation rate was 20%.
39 patients (28%) stopped due to disease progression, 14 patients (10%) due to lymphopenia, and 55 patients (39%) due to side effects, with the remaining 33 (23%) stopping for a range of other reasons.
The peak period for discontinuation due to side effects was 3-5 weeks after starting treatment. Discontinuation due to lymphopenia peaked at 7-12 months, and for disease progression was after more than 1 year on treatment. 73% of patients who experienced side effects were offered an alternative drug. 17% were given a temporary dose reduction. The majority of patients discussed their side effects with either their neurologist or their MS nurse. 26% of patients stopped with no discussion with a health care professional.
Conclusion: This real world data shows the rate of discontinuation of DMF due to side effects to be greater than that reported in clinical trials. A significant number of patients are stopping treatment with DMF due to side effects and being switched to alternative therapy. This has implications both for the patient & the MS service. By identifying the peak time for discontinuation due to side effects the MS team can target follow up with these patients at 2 weeks & offer telephone counselling from an appropriately trained pharmacist or MS nurse to improve management of side effects & adherence to therapy.
Disclosure:
Esfahani Motlagh B Nothing to declare
Quinn T Nothing to declare
Dorsey-Campbell R Educational meetings honorarium, advisory board or conference attendance sponsored by Biogen Idec, Roche, Sanofi Genzyme & Novartis
Delacruz D Nothing to declare
Felongco T Nothing to declare
Walters P Nothing to declare
Scalfari A Nothing to declare
Singh-Curry V
Malik O
Nicholas R. Novartis, Genzyme, Biogen Idec honorarium for speaking, advisory boards, Roche - advisory boards, CASTINGS committee member
Abstract: EP1698
Type: ePoster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Introduction: Dimethyl fumarate (DMF) is an oral disease modifying therapy (DMT) licensed to treat relapsing multiple sclerosis (RMS). The rate of discontinuation due to adverse effects in the pivotal trials was 12-16%. We aimed to determine the stopping rate at Imperial College Healthcare NHS Trust (ICHNT) and the reasons for its discontinuation.
Method: Patients who discontinued DMF were identified from a local database. These patients were interviewed using a telephone questionnaire. The reasons for stopping treatment were recorded. Patients who had stopped due to side effects were asked to identify which health care professional they had contacted prior to this decision. Information on subsequent treatment choices was also obtained.
Results: ICHNT recorded 352 patients being treated with DMF. 142 (29%) patients were identified as having stopped treatment. Excluding those stopping for progression the discontinuation rate was 20%.
39 patients (28%) stopped due to disease progression, 14 patients (10%) due to lymphopenia, and 55 patients (39%) due to side effects, with the remaining 33 (23%) stopping for a range of other reasons.
The peak period for discontinuation due to side effects was 3-5 weeks after starting treatment. Discontinuation due to lymphopenia peaked at 7-12 months, and for disease progression was after more than 1 year on treatment. 73% of patients who experienced side effects were offered an alternative drug. 17% were given a temporary dose reduction. The majority of patients discussed their side effects with either their neurologist or their MS nurse. 26% of patients stopped with no discussion with a health care professional.
Conclusion: This real world data shows the rate of discontinuation of DMF due to side effects to be greater than that reported in clinical trials. A significant number of patients are stopping treatment with DMF due to side effects and being switched to alternative therapy. This has implications both for the patient & the MS service. By identifying the peak time for discontinuation due to side effects the MS team can target follow up with these patients at 2 weeks & offer telephone counselling from an appropriately trained pharmacist or MS nurse to improve management of side effects & adherence to therapy.
Disclosure:
Esfahani Motlagh B Nothing to declare
Quinn T Nothing to declare
Dorsey-Campbell R Educational meetings honorarium, advisory board or conference attendance sponsored by Biogen Idec, Roche, Sanofi Genzyme & Novartis
Delacruz D Nothing to declare
Felongco T Nothing to declare
Walters P Nothing to declare
Scalfari A Nothing to declare
Singh-Curry V
Malik O
Nicholas R. Novartis, Genzyme, Biogen Idec honorarium for speaking, advisory boards, Roche - advisory boards, CASTINGS committee member