Contributions
Abstract: P599
Type: Poster Sessions
Abstract Category: Therapy - Long-term treatment monitoring
Background: The Czech national registry ReMuS has been collecting data on more than 13,000 multiple sclerosis (MS) patients since 2013. Among others, the data indicates the influence of reimbursement criteria on the accessibility and utilization of various first disease-modifying drugs (DMD).
Objective: To describe the temporal evolution of treatment commencement in the Czech Republic and estimate factors influencing treatment effect.
Methods: The study included patients starting with first-line therapy (glatiramer acetate, interferon beta, teriflunomide) or starting directly with more effective but costlier escalation therapy (alemtuzumab, dimethyl fumarate, fingolimod, natalizumab). MS patients initiating DMD between 2013-2016 were identified from the respective DMD start date. We explored the relationship between the type of DMD treatment and the severity of MS before and shortly after DMD start. Probability of having relapse within 1 year after DMD initiation was modelled using logistic regression to access the effect of Expanded Disability Status Scale (EDSS) one year before DMD and the effect of number of previous relapses with regards to other characteristics (age, sex, disease duration). Differences in covariates between patients starting therapy in years 2013-2016 were explored using ANOVA.
Results: Out of 3,328 patients, 3,203 started on first-line therapy and 125 started directly on escalation therapy. The proportion of patients starting on escalation therapy increased in time (1.8% in 2013 and 4.7% in 2016). The occurrence of a relapse one year after DMD initiation is significantly connected with the EDSS one year before DMD (p< 0.001, higher EDSS is associated with higher probability of a relapse) and the number of previous relapses (p< 0.001, patients with ≥2 prior relapses were more likely to have further relapse). Both the average EDSS and the number of relapses prior to DMD are significantly lower (p=0.002 and 0.018) in patients starting the first DMD in later years of the explored interval.
Conclusions: The data from the national registry ReMuS showing decreasing EDSS and number of relapses prior to the first DMD treatment over time evidences the improving management of MS in the Czech Republic. Despite these trends, the rate of patients starting directly on escalation drugs is still low and does not correspond to the estimated number of patients with highly-active disease nor treatment trends in countries with no economic restrictions.
Disclosure: Dana Horakova received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, Roche, and Teva, as well as support for research activities from Biogen Idec.
Tereza Hrnciarova has nothing to disclose
Jitka Jircikova has nothing to disclose
Tomas Dolezal has nothing to disclose
Marta Vachova has nothing to disclose
Pavel Hradilek has nothing to disclose
Martin Valis has nothing to disclose
Jaroslava Sucha has nothing to disclose
Alena Martinkova has nothing to disclose
Radek Ampapa has nothing to disclose
Marketa Grunermelova has nothing to disclose
Ivana Stetkarova has nothing to disclose
Pavel Stourac has nothing to disclose
Jan Mares has nothing to disclose
Jana Adamkova has nothing to disclose
Michal Dufek has nothing to disclose
Eva Kmetova has nothing to disclose
Petra Rockova has nothing to disclose
Abstract: P599
Type: Poster Sessions
Abstract Category: Therapy - Long-term treatment monitoring
Background: The Czech national registry ReMuS has been collecting data on more than 13,000 multiple sclerosis (MS) patients since 2013. Among others, the data indicates the influence of reimbursement criteria on the accessibility and utilization of various first disease-modifying drugs (DMD).
Objective: To describe the temporal evolution of treatment commencement in the Czech Republic and estimate factors influencing treatment effect.
Methods: The study included patients starting with first-line therapy (glatiramer acetate, interferon beta, teriflunomide) or starting directly with more effective but costlier escalation therapy (alemtuzumab, dimethyl fumarate, fingolimod, natalizumab). MS patients initiating DMD between 2013-2016 were identified from the respective DMD start date. We explored the relationship between the type of DMD treatment and the severity of MS before and shortly after DMD start. Probability of having relapse within 1 year after DMD initiation was modelled using logistic regression to access the effect of Expanded Disability Status Scale (EDSS) one year before DMD and the effect of number of previous relapses with regards to other characteristics (age, sex, disease duration). Differences in covariates between patients starting therapy in years 2013-2016 were explored using ANOVA.
Results: Out of 3,328 patients, 3,203 started on first-line therapy and 125 started directly on escalation therapy. The proportion of patients starting on escalation therapy increased in time (1.8% in 2013 and 4.7% in 2016). The occurrence of a relapse one year after DMD initiation is significantly connected with the EDSS one year before DMD (p< 0.001, higher EDSS is associated with higher probability of a relapse) and the number of previous relapses (p< 0.001, patients with ≥2 prior relapses were more likely to have further relapse). Both the average EDSS and the number of relapses prior to DMD are significantly lower (p=0.002 and 0.018) in patients starting the first DMD in later years of the explored interval.
Conclusions: The data from the national registry ReMuS showing decreasing EDSS and number of relapses prior to the first DMD treatment over time evidences the improving management of MS in the Czech Republic. Despite these trends, the rate of patients starting directly on escalation drugs is still low and does not correspond to the estimated number of patients with highly-active disease nor treatment trends in countries with no economic restrictions.
Disclosure: Dana Horakova received compensation for travel, speaker honoraria and consultant fees from Biogen Idec, Novartis, Merck, Bayer, Sanofi Genzyme, Roche, and Teva, as well as support for research activities from Biogen Idec.
Tereza Hrnciarova has nothing to disclose
Jitka Jircikova has nothing to disclose
Tomas Dolezal has nothing to disclose
Marta Vachova has nothing to disclose
Pavel Hradilek has nothing to disclose
Martin Valis has nothing to disclose
Jaroslava Sucha has nothing to disclose
Alena Martinkova has nothing to disclose
Radek Ampapa has nothing to disclose
Marketa Grunermelova has nothing to disclose
Ivana Stetkarova has nothing to disclose
Pavel Stourac has nothing to disclose
Jan Mares has nothing to disclose
Jana Adamkova has nothing to disclose
Michal Dufek has nothing to disclose
Eva Kmetova has nothing to disclose
Petra Rockova has nothing to disclose