Contributions
Abstract: EP1792
Type: ePoster
Abstract Category: Therapy - disease modifying - 32 Others
Background: In recent years there has been an increasing availability of disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis (RRMS), including oral drugs. The common perception is that these oral drugs are more accepted and tolerated by patients than self-injectable DMTs. However, evidence that the route of administration has a relevant effect on persistence to treatment is not established yet.
Objective: To investigate the short-term persistence to treatment with self-injectable or oral DMTs in patients with RRMS.
Methods: We retrospectively collected data of patients attending 21 Italian MS Centres and one MS Centre in Wales, UK. Patients were considered eligible if they started a self-injectable or oral DMT (excluding fingolimod) from January to December 2015. We estimated the proportion of patients discontinuing the treatment within a follow-up period of 12 months and analysed reasons for discontinuation. A Cox regression model (stratified by Centre) was run to explore baseline predictors of treatment discontinuation.
Results: We analyzed data of 1,841 consecutive patients (1,293 F, 548 M) with a mean age of 40 years and median EDSS of 2.0. Of them, 631 (34%) were treatment-naïve, while the remaining 1,210 (66%) were switched from another DMT. The most frequently prescribed treatment was dimethyl fumarate (n=1,050; 57%), followed by teriflunomide (n=174, 15%), glatiramer acetate (GA) 20 or 40 mg (n=175; 9.5%), low-frequency (LF) i.m. or s.c. pegylated Interferon beta (IFNB)-1a (n=174, 9.5%), high-frequency (HF) s.c. IFNB-1a or 1-b (n=165, 9%).
A total of 366 (20%) patients discontinued the prescribed DMT after a median time of 6 months due to lack of tolerance (n=166), disease activity (n=98), adverse event (n=62), pregnancy planning (n=22) or unspecified reasons (n=21).
The highest discontinuation rate was observed in patients treated with LF-IFNB (p< 0.02 versus each other DMT). There was no significant difference in discontinuation rate between oral drugs and HF-IFNB or GA (p>0.3). Female sex (HR=1.45, p=0.003) and previous exposure to >2 DMTs (HR=1.66, p=0.009) were other independent risk factors for treatment discontinuation.
Discussion: Poor tolerability was the most common cause of treatment discontinuation in the short-term period. Oral drugs did not show a better tolerability with respect to self-injectable DMTs. Persistence to treatment represents a clinical challenge, irrespective of the route of administration.
Disclosure:
LP: consulting fees from Biogen, Novartis and Roche; speaker honoraria from Biogen, Genzyme, Merck Serono, Novartis and Teva; travel grants from Biogen, Genzyme, Novartis and Teva; research grants from the Italian MS Society (Associazione Italiana Sclerosi Multipla) and Genzyme.
RL: personal fees and financial support from Almirall, Novartis, Merck Serono, Biogen, Teva, Genzyme.
RF: honoraria for speaking or consultation fees from Almirall, Merck Serono, Novartis, Sanofi, Teva, Biogen; advisory board membership of Teva, Biogen, Merck Serono, Novartis.
MM has nothing to disclose.
VN has nothing to disclose.
CG: fees as invited speaker or travel expenses for attending meeting from Biogen, Merck-Serono, Teva, Sanofi, Novartis, Genzyme.
CT: honoraria for speaking and travel grant from Biogen, Sanofi-Aventis, Merck Serono, Bayer-Schering, Teva, Genzyme, Almirall and Novartis.
PA: honoraria for lecturing and participation in advisory boards, and travel expenses for attending congresses and meetings from Merck Serono, Biogen, Teva, Sanofi-Aventis, Almirall, Roche and Novartis.
PC: honoraria for consultancy or speaking from Almirall, Biogen, Merck-Serono, Novartis, Sanofi-Genzyme, Teva.
MR has nothing to disclose.
SM has nothing to disclose.
VTC: advisory board membership of Novartis and Merck-Serono; funding for traveling and honoraria for speaking or writing from Teva, Biogen, Genzyme, Merk-Serono and Almirall; support for research project by Almirall.
LB has nothing to disclose.
FB: advisory board membership of Teva and Merck Serono; honoraria for speaking or consultation fees from Almirall, Biogen Idec, Genzyme, Merck Serono, Novartis, Teva.
PR: honoraria for consultancies, speaking, or travel expenses from: Biogen idec, Merck Serono, Novartis, Sanofi-Genzyme and Teva pharmaceuticals.
GTM: travel assistance and/or honoraria for advice to Biogen, Novartis, Genzyme, Sanofi-Aventis and Merck-Serono.
MDF: nothing to disclose.
MCB: advisory board membership and honoraria for speaking from Teva, Novartis, Sanofi, Merck Serono and Biogen.
FP has nothing to disclose.
AG has nothing to disclose.
EC has nothing to disclose.
GC has nothing to disclose.
IP has nothing to disclose.
AL has nothing to disclose.
AG: honoraria to participate in advisory boards and travel support from Merck Serono.
MC: honoraria for reasearch or speaking from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Bayer, Novartis Pharma and funds for travel from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Teva, Novartis Pharma, Roche and Bayer.
VT has nothing to disclose.
CS: advisory board membership of the following companies: Biogen and Merck Serono; speaking honoraria from Bayer Schering, Biogen, Merck Serono, Almirall, Teva, Genzyme; research grants and support from the Italian MS Society Research Foundation (Fondazione Italiana Sclerosi Multipla)
Abstract: EP1792
Type: ePoster
Abstract Category: Therapy - disease modifying - 32 Others
Background: In recent years there has been an increasing availability of disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis (RRMS), including oral drugs. The common perception is that these oral drugs are more accepted and tolerated by patients than self-injectable DMTs. However, evidence that the route of administration has a relevant effect on persistence to treatment is not established yet.
Objective: To investigate the short-term persistence to treatment with self-injectable or oral DMTs in patients with RRMS.
Methods: We retrospectively collected data of patients attending 21 Italian MS Centres and one MS Centre in Wales, UK. Patients were considered eligible if they started a self-injectable or oral DMT (excluding fingolimod) from January to December 2015. We estimated the proportion of patients discontinuing the treatment within a follow-up period of 12 months and analysed reasons for discontinuation. A Cox regression model (stratified by Centre) was run to explore baseline predictors of treatment discontinuation.
Results: We analyzed data of 1,841 consecutive patients (1,293 F, 548 M) with a mean age of 40 years and median EDSS of 2.0. Of them, 631 (34%) were treatment-naïve, while the remaining 1,210 (66%) were switched from another DMT. The most frequently prescribed treatment was dimethyl fumarate (n=1,050; 57%), followed by teriflunomide (n=174, 15%), glatiramer acetate (GA) 20 or 40 mg (n=175; 9.5%), low-frequency (LF) i.m. or s.c. pegylated Interferon beta (IFNB)-1a (n=174, 9.5%), high-frequency (HF) s.c. IFNB-1a or 1-b (n=165, 9%).
A total of 366 (20%) patients discontinued the prescribed DMT after a median time of 6 months due to lack of tolerance (n=166), disease activity (n=98), adverse event (n=62), pregnancy planning (n=22) or unspecified reasons (n=21).
The highest discontinuation rate was observed in patients treated with LF-IFNB (p< 0.02 versus each other DMT). There was no significant difference in discontinuation rate between oral drugs and HF-IFNB or GA (p>0.3). Female sex (HR=1.45, p=0.003) and previous exposure to >2 DMTs (HR=1.66, p=0.009) were other independent risk factors for treatment discontinuation.
Discussion: Poor tolerability was the most common cause of treatment discontinuation in the short-term period. Oral drugs did not show a better tolerability with respect to self-injectable DMTs. Persistence to treatment represents a clinical challenge, irrespective of the route of administration.
Disclosure:
LP: consulting fees from Biogen, Novartis and Roche; speaker honoraria from Biogen, Genzyme, Merck Serono, Novartis and Teva; travel grants from Biogen, Genzyme, Novartis and Teva; research grants from the Italian MS Society (Associazione Italiana Sclerosi Multipla) and Genzyme.
RL: personal fees and financial support from Almirall, Novartis, Merck Serono, Biogen, Teva, Genzyme.
RF: honoraria for speaking or consultation fees from Almirall, Merck Serono, Novartis, Sanofi, Teva, Biogen; advisory board membership of Teva, Biogen, Merck Serono, Novartis.
MM has nothing to disclose.
VN has nothing to disclose.
CG: fees as invited speaker or travel expenses for attending meeting from Biogen, Merck-Serono, Teva, Sanofi, Novartis, Genzyme.
CT: honoraria for speaking and travel grant from Biogen, Sanofi-Aventis, Merck Serono, Bayer-Schering, Teva, Genzyme, Almirall and Novartis.
PA: honoraria for lecturing and participation in advisory boards, and travel expenses for attending congresses and meetings from Merck Serono, Biogen, Teva, Sanofi-Aventis, Almirall, Roche and Novartis.
PC: honoraria for consultancy or speaking from Almirall, Biogen, Merck-Serono, Novartis, Sanofi-Genzyme, Teva.
MR has nothing to disclose.
SM has nothing to disclose.
VTC: advisory board membership of Novartis and Merck-Serono; funding for traveling and honoraria for speaking or writing from Teva, Biogen, Genzyme, Merk-Serono and Almirall; support for research project by Almirall.
LB has nothing to disclose.
FB: advisory board membership of Teva and Merck Serono; honoraria for speaking or consultation fees from Almirall, Biogen Idec, Genzyme, Merck Serono, Novartis, Teva.
PR: honoraria for consultancies, speaking, or travel expenses from: Biogen idec, Merck Serono, Novartis, Sanofi-Genzyme and Teva pharmaceuticals.
GTM: travel assistance and/or honoraria for advice to Biogen, Novartis, Genzyme, Sanofi-Aventis and Merck-Serono.
MDF: nothing to disclose.
MCB: advisory board membership and honoraria for speaking from Teva, Novartis, Sanofi, Merck Serono and Biogen.
FP has nothing to disclose.
AG has nothing to disclose.
EC has nothing to disclose.
GC has nothing to disclose.
IP has nothing to disclose.
AL has nothing to disclose.
AG: honoraria to participate in advisory boards and travel support from Merck Serono.
MC: honoraria for reasearch or speaking from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Bayer, Novartis Pharma and funds for travel from Sanofi-Genzyme, Merck-Serono, Biogen Idec, Teva, Novartis Pharma, Roche and Bayer.
VT has nothing to disclose.
CS: advisory board membership of the following companies: Biogen and Merck Serono; speaking honoraria from Bayer Schering, Biogen, Merck Serono, Almirall, Teva, Genzyme; research grants and support from the Italian MS Society Research Foundation (Fondazione Italiana Sclerosi Multipla)