Contributions
Abstract: EP1708
Type: ePoster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Background: Twelve disease-modifying therapies (DMTs) specific for multiple sclerosis (MS) are now available in France, whom three are oral medications (fingolimod, dimethyl fumarate, teriflunomide).
A higher adherence to oral drugs may be expected compared to injectable ones. To our knowledge, no study has compared adherence in patients who received both types of DMTs over time.
Objective: From administrative databases we aimed to compare adherence to DMTs according to their route of administration - oral vs injectable - within a unique group of patients, who switched from injectable to oral drugs.
Methods: People with MS were identified between 2011 and 2015 in a random sample of French healthcare insurance system thanks to a three-criterion algorithm using diagnoses of hospital admissions, DMTs and MS long disease duration status. Only patients who went from an injectable to an oral DMT over the study period (2011 to 2015) were selected (all duration between the two DMTs were considered). Adherence was estimated using the medical possession ratio (MPR), a threshold of ≥0.8 being considered as optimal adherence. For each DMT it was calculated from the date of first dispensation (index date) to either estimated end of treatment or the end of follow-up on 31st December 2015. Differences between injectable and oral DMTs regarding MPR and proportion of optimal adherence were tested with a paired sign rank test and a McNemar's test respectively.
Results: A switch from an injectable to an oral DMT was identified for 100 out of 1,153 patients with MS. Median age was 45 years and 67% were female. Median treatment duration was 846.5 and 296.0 days for injectable and oral DMTs respectively. Mean MPR was higher for oral compared to injectable DMTs (0.97 vs 0.89, p< 0.001). The proportion of optimal adherence differed significantly between oral and injectable (93% vs 76%, p< 0.001). Results were consistent when selecting a minimum of 6-month DMTs duration (97% vs 75%, p< 0.001).
Conclusion: In patients who switched from injectable to oral DMTs, we found higher adherence for oral DMTs than injectable ones. It may reveal that reason for switching was lack of adherence or injections' weariness. However, high adherence to oral DMTs may also be linked to the limited treatment duration and may decrease over time. We plan to assess adherence also in non-switchers (only oral or only injectable), and for each DMT separately. Comprehensive results will be available in October 2017.
Disclosure: This work was supported by the French National Agency for Medicines and Health Products Safety (ANSM).
Jonathan Roux was funded as PhD fellowship by the French National Agency for Medicines and Health Products Safety (ANSM) for this work.
Alice Guilleux has no disclosure to report.
Emmanuelle Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, outside the submitted work, and travel grants from Novartis and Roche SAS. Sources of funding in the last year came from the French ARSEP Foundation, the French National Security Agency for Medicines and Health Products, the EDMUS Foundation, and donation from Roche SAS.
Abstract: EP1708
Type: ePoster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Background: Twelve disease-modifying therapies (DMTs) specific for multiple sclerosis (MS) are now available in France, whom three are oral medications (fingolimod, dimethyl fumarate, teriflunomide).
A higher adherence to oral drugs may be expected compared to injectable ones. To our knowledge, no study has compared adherence in patients who received both types of DMTs over time.
Objective: From administrative databases we aimed to compare adherence to DMTs according to their route of administration - oral vs injectable - within a unique group of patients, who switched from injectable to oral drugs.
Methods: People with MS were identified between 2011 and 2015 in a random sample of French healthcare insurance system thanks to a three-criterion algorithm using diagnoses of hospital admissions, DMTs and MS long disease duration status. Only patients who went from an injectable to an oral DMT over the study period (2011 to 2015) were selected (all duration between the two DMTs were considered). Adherence was estimated using the medical possession ratio (MPR), a threshold of ≥0.8 being considered as optimal adherence. For each DMT it was calculated from the date of first dispensation (index date) to either estimated end of treatment or the end of follow-up on 31st December 2015. Differences between injectable and oral DMTs regarding MPR and proportion of optimal adherence were tested with a paired sign rank test and a McNemar's test respectively.
Results: A switch from an injectable to an oral DMT was identified for 100 out of 1,153 patients with MS. Median age was 45 years and 67% were female. Median treatment duration was 846.5 and 296.0 days for injectable and oral DMTs respectively. Mean MPR was higher for oral compared to injectable DMTs (0.97 vs 0.89, p< 0.001). The proportion of optimal adherence differed significantly between oral and injectable (93% vs 76%, p< 0.001). Results were consistent when selecting a minimum of 6-month DMTs duration (97% vs 75%, p< 0.001).
Conclusion: In patients who switched from injectable to oral DMTs, we found higher adherence for oral DMTs than injectable ones. It may reveal that reason for switching was lack of adherence or injections' weariness. However, high adherence to oral DMTs may also be linked to the limited treatment duration and may decrease over time. We plan to assess adherence also in non-switchers (only oral or only injectable), and for each DMT separately. Comprehensive results will be available in October 2017.
Disclosure: This work was supported by the French National Agency for Medicines and Health Products Safety (ANSM).
Jonathan Roux was funded as PhD fellowship by the French National Agency for Medicines and Health Products Safety (ANSM) for this work.
Alice Guilleux has no disclosure to report.
Emmanuelle Leray reports personal fees as speaker or consultant from Novartis and Sanofi Genzyme, outside the submitted work, and travel grants from Novartis and Roche SAS. Sources of funding in the last year came from the French ARSEP Foundation, the French National Security Agency for Medicines and Health Products, the EDMUS Foundation, and donation from Roche SAS.