Contributions
Abstract: P1199
Type: Poster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Background: MS patients are nowadays offered a broad choice of immunomodulating therapies (DMTs) which can be individually tailored. However, they are associated with different degrees of effectiveness and risks of adverse events. These leads to frequent changes of therapy. Reasons for discontinuation can be different, and complex switching patterns of MS therapy are difficult to monitor with traditional tools.
Objectives: To develop a flexible system for monitoring of discontinuation, switching and restarting of DMTs. The system allows assessment of the eventual fate of naïve treatments by following subsequent switches in a forward direction, as well as current therapies, in a reverse direction, to monitor the path by which patients ended up in the current treatment regime.
Methods: All neurological clinics in Sweden contribute DMT data into the Swedish MS Registry (SMSreg) on a regular, although voluntary basis. SMSreg has over 80% coverage of all prevalent Swedish MS patients (16,500 of 20,000). The total number of registered DMT episodes is 31,800 on 13,800 unique MS patients with 10,000 ongoing treatments.
The Visualization and Analysis Platform (VAP) provides graphs and tables on SMSreg's data in real-time. It is built in SQL and R, using a collection of R libraries and utilizing Shiny, a powerful tool for web-visualization. A specific type of flow diagrams - the Sankey diagram was used to visualize DMT switches. The width of arrows (representing switches between two drugs) is proportional to the flow quantity (actual proportion of patients switching from one drug to another). Treatment data are automatically retrieved from the SMS registry.
Results: Monitoring of switches in VAP at national and county levels involves customizable diagrams. First type ot them starts from a group of first DMT episodes that goes forward to the next DMTs, depicting different switches with separate bands of arrows. Another type goes in a reverse direction from the group of patients with a current treatment, back to first registered treatments. Divisions by gender, clinical course and reason for discontinuation are implemented. Numbers of switching patients are interactively displayed on the graphs.
Conclusions: The system offers flexible, graphical monitoring of treatment switches. With the help of Sankey diagrams, a unique visualization of this complex issue is possible. It provides complimentary information on treatment patterns, which are already monitored by VAP in SMSreg.
Disclosure: EH and LS declares no conflict of interest.
JH has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker's fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from BiogenIdec, Merck-Serono, TEVA, Sanofi-Genzyme and Bayer-Schering. His MS research is funded by the Swedish Research Council and the Swedish Brain foundation.
Abstract: P1199
Type: Poster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Background: MS patients are nowadays offered a broad choice of immunomodulating therapies (DMTs) which can be individually tailored. However, they are associated with different degrees of effectiveness and risks of adverse events. These leads to frequent changes of therapy. Reasons for discontinuation can be different, and complex switching patterns of MS therapy are difficult to monitor with traditional tools.
Objectives: To develop a flexible system for monitoring of discontinuation, switching and restarting of DMTs. The system allows assessment of the eventual fate of naïve treatments by following subsequent switches in a forward direction, as well as current therapies, in a reverse direction, to monitor the path by which patients ended up in the current treatment regime.
Methods: All neurological clinics in Sweden contribute DMT data into the Swedish MS Registry (SMSreg) on a regular, although voluntary basis. SMSreg has over 80% coverage of all prevalent Swedish MS patients (16,500 of 20,000). The total number of registered DMT episodes is 31,800 on 13,800 unique MS patients with 10,000 ongoing treatments.
The Visualization and Analysis Platform (VAP) provides graphs and tables on SMSreg's data in real-time. It is built in SQL and R, using a collection of R libraries and utilizing Shiny, a powerful tool for web-visualization. A specific type of flow diagrams - the Sankey diagram was used to visualize DMT switches. The width of arrows (representing switches between two drugs) is proportional to the flow quantity (actual proportion of patients switching from one drug to another). Treatment data are automatically retrieved from the SMS registry.
Results: Monitoring of switches in VAP at national and county levels involves customizable diagrams. First type ot them starts from a group of first DMT episodes that goes forward to the next DMTs, depicting different switches with separate bands of arrows. Another type goes in a reverse direction from the group of patients with a current treatment, back to first registered treatments. Divisions by gender, clinical course and reason for discontinuation are implemented. Numbers of switching patients are interactively displayed on the graphs.
Conclusions: The system offers flexible, graphical monitoring of treatment switches. With the help of Sankey diagrams, a unique visualization of this complex issue is possible. It provides complimentary information on treatment patterns, which are already monitored by VAP in SMSreg.
Disclosure: EH and LS declares no conflict of interest.
JH has received honoraria for serving on advisory boards for Biogen, Sanofi-Genzyme and Novartis and speaker's fees from Biogen, Novartis, Merck-Serono, Bayer-Schering, Teva and Sanofi-Genzyme. He has served as P.I. for projects, or received unrestricted research support from BiogenIdec, Merck-Serono, TEVA, Sanofi-Genzyme and Bayer-Schering. His MS research is funded by the Swedish Research Council and the Swedish Brain foundation.