Contributions
Abstract: P809
Type: Poster
Abstract Category: Therapy - symptomatic - 33 Treatment of specific symptoms
Background: Relapse resolution in multiple sclerosis (MS) is critical, given relapses may last a few days to several weeks or months and leave residual deficits. Our goal was to identify patients with MS relapse and to evaluate unresolved relapses from the Humana Research Database. Humana policy considers corticosteroids (CS) to be first-line relapse therapy; other therapies include repository corticotropin injection (RCI; H.P.Acthar® Gel), intravenous immunoglobulin (IVIG), or plasmapheresis (PMP). Since oral CS are often used first, we focused on intravenous CS (IVMP), RCI, IVIG, and PMP.
Methods: Retrospective analyses were conducted using Humana's Commercial and Medicare Advantage claims data from 1/1/08 - 7/31/15. An MS relapse event was defined as a hospitalization with a principal diagnosis of MS (ICD-9-CM 340.xx) or outpatient visit with MS diagnosis and a medical or pharmacy claim for treatment (CS, RCI, IVIG, PMP) within 30 days. The first relapse event and treatment in the study period were considered the index event and treatment. Relapse events were unresolved if >1 relapses occurred within 30 days. No minimum enrollment was required. Proportions and annualized rates of relapse (ARR) were calculated.
Results: 9,574 patients with ≥1 relapses were identified. Per year, 74.0% patients had < 2 relapses, 20.6% had 2-4 relapses, and 5.4% had >4 relapses (ARR). 3,532 patients (36.9%) had ≥1 unresolved relapses. A total of 25,162 relapses were identified; 51.8% of relapses were treated with oral CS, 38.6% with IVMP, 6.0% with IVIG, 2.2% with RCI, and 1.5% with PMP. Patients usually continued with their first observed treatment for subsequent relapses. In index event analyses, 47.8% of patients treated with IVMP had no unresolved relapses; 96.9%, 50.7%, and 43.9% of patients treated with RCI, PMP, and IVIG had no unresolved relapses, respectively.
Conclusions: Relapse rates and unresolved relapses remain a challenge in MS. 26.0% of patients had ≥2 relapses per year. Among those with ≥1 relapses, 36.9% had unresolved relapses. Of treatments evaluated, RCI had the lowest proportion of unresolved relapses. Relapse resolution is an important indicator of treatment effectiveness. Limitations apply: claims reflect treatment-seeking behavior and lack clinical detail, IVMP may be followed by an oral CS taper by design, index events were first observed not incident, and unrestricted enrollment was used. Our study should be repeated with fixed enrollment.
Source of funding: This study was funded by Mallinckrodt Pharmaceuticals, Inc.
Disclosure:
Manasi Datar: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Richard Sheer: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Phil Schwab: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Tara Nazareth: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.
Tzy-Chyi Yu: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.
Abstract: P809
Type: Poster
Abstract Category: Therapy - symptomatic - 33 Treatment of specific symptoms
Background: Relapse resolution in multiple sclerosis (MS) is critical, given relapses may last a few days to several weeks or months and leave residual deficits. Our goal was to identify patients with MS relapse and to evaluate unresolved relapses from the Humana Research Database. Humana policy considers corticosteroids (CS) to be first-line relapse therapy; other therapies include repository corticotropin injection (RCI; H.P.Acthar® Gel), intravenous immunoglobulin (IVIG), or plasmapheresis (PMP). Since oral CS are often used first, we focused on intravenous CS (IVMP), RCI, IVIG, and PMP.
Methods: Retrospective analyses were conducted using Humana's Commercial and Medicare Advantage claims data from 1/1/08 - 7/31/15. An MS relapse event was defined as a hospitalization with a principal diagnosis of MS (ICD-9-CM 340.xx) or outpatient visit with MS diagnosis and a medical or pharmacy claim for treatment (CS, RCI, IVIG, PMP) within 30 days. The first relapse event and treatment in the study period were considered the index event and treatment. Relapse events were unresolved if >1 relapses occurred within 30 days. No minimum enrollment was required. Proportions and annualized rates of relapse (ARR) were calculated.
Results: 9,574 patients with ≥1 relapses were identified. Per year, 74.0% patients had < 2 relapses, 20.6% had 2-4 relapses, and 5.4% had >4 relapses (ARR). 3,532 patients (36.9%) had ≥1 unresolved relapses. A total of 25,162 relapses were identified; 51.8% of relapses were treated with oral CS, 38.6% with IVMP, 6.0% with IVIG, 2.2% with RCI, and 1.5% with PMP. Patients usually continued with their first observed treatment for subsequent relapses. In index event analyses, 47.8% of patients treated with IVMP had no unresolved relapses; 96.9%, 50.7%, and 43.9% of patients treated with RCI, PMP, and IVIG had no unresolved relapses, respectively.
Conclusions: Relapse rates and unresolved relapses remain a challenge in MS. 26.0% of patients had ≥2 relapses per year. Among those with ≥1 relapses, 36.9% had unresolved relapses. Of treatments evaluated, RCI had the lowest proportion of unresolved relapses. Relapse resolution is an important indicator of treatment effectiveness. Limitations apply: claims reflect treatment-seeking behavior and lack clinical detail, IVMP may be followed by an oral CS taper by design, index events were first observed not incident, and unrestricted enrollment was used. Our study should be repeated with fixed enrollment.
Source of funding: This study was funded by Mallinckrodt Pharmaceuticals, Inc.
Disclosure:
Manasi Datar: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Richard Sheer: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Phil Schwab: A shareholder of Humana Inc. and an employee of Comprehensive Health Insights, Inc., a wholly-owned subsidiary of Humana Inc.
Tara Nazareth: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.
Tzy-Chyi Yu: An employee and stock holder of Mallinckrodt Pharmaceuticals, Inc.