Abstract: EP1439
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Economic burden
Introduction: In the last decade we have increased our therapeutic arsenal (DMTs) for multiple sclerosis (MS). In our country, natalizumab was authorised in the mid 2007, fingolimod in dec-2011, alemtuzumab, teriflunomide, and dimethyl-fumarate, in may-2015. Budget impact (BI) has progressively grown along this period.
Objective: To analyze persistence of DMTs along the three different stages marked by the introduction of new DMTs, and reasons for switch to sencond-line therapies. Description of costs related to these drugs was included.
Methods: This is a 9-years retrospective, uni-center study. Prescription and dispensing were digitally registered from january 2009. We defined first stage corresponding to jan-2009 to dec-2011, second stage from dec-2011 to may-2015, and third sage from may-2015 to feb-2018
Statistics: Chi2, Kaplan-Meyer curve (log-rank method for comparison) and non-parametric comparison of medians were used.
Results: Along this 9-y period, we prescribed 535 treatments (142, 179, and 214 respectively to each stage) in a total of 338 patients. A total of 290 patients are still on treatment. Most interferons (IFN) were suspended along this 9y period, independently of the stage (86.5% of first stage, 63.3% of sencond stage, and 70.6% of third stage), mainly for inefficacy. From the first stage, only 13 IFN remain active, but 6 (33.3%) of AG, and 8 (32%) of NTZ remain active. In the third stage, more than 80% DMTs remain active, except for DMF (68.9%) and IFN1A (29.4%).
Contrary to that expected, 17%, 23.91% and 35.3%, respectively of DMTs prescribed in the first, second or third stage were switched to new oral therapies. Switches from first to second line therapies decreased along this 9y period from 37.32% in the first stage, 12.29% in the second stage, and 8.87% in the third stage. The evolution of spending on these drugs has been linearly increasing during the first 7 y by 20%, afterwards it reduced to 15% in the last 2 y. Kaplan-Meyer curves demostrated that oral therapies were more persistent than injectables (log-rank p=0.001).
Conclusions: We have found that oral and second line therapies were associated with longer persistance on treatment. The use of IFN, was associated with higher probability to switch to second-line therapies.
The more persistent new oral treatments could be related to the reduction in the evolution of BI due to these drugs because of decreased switch to more expensive second-line therapies.
Disclosure: Agustin Oterino has received honoraria for speaking from Sanofi, Biogen, Teva, Merck, Almirall, Allergan,Novartis, and Roche.
David Gómez has nothing to disclose
David Cantarero has nothing to disclose
Carla Blazquez has nothing to disclose
Maria Toriello has nothing to disclose
Sara Perez has nothing to disclose
Vicente G Quintanilla has received honoraria for speaking from Novartis, and Sanofi.
This work has been funded bay Sanofi-Genzyme
Abstract: EP1439
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Economic burden
Introduction: In the last decade we have increased our therapeutic arsenal (DMTs) for multiple sclerosis (MS). In our country, natalizumab was authorised in the mid 2007, fingolimod in dec-2011, alemtuzumab, teriflunomide, and dimethyl-fumarate, in may-2015. Budget impact (BI) has progressively grown along this period.
Objective: To analyze persistence of DMTs along the three different stages marked by the introduction of new DMTs, and reasons for switch to sencond-line therapies. Description of costs related to these drugs was included.
Methods: This is a 9-years retrospective, uni-center study. Prescription and dispensing were digitally registered from january 2009. We defined first stage corresponding to jan-2009 to dec-2011, second stage from dec-2011 to may-2015, and third sage from may-2015 to feb-2018
Statistics: Chi2, Kaplan-Meyer curve (log-rank method for comparison) and non-parametric comparison of medians were used.
Results: Along this 9-y period, we prescribed 535 treatments (142, 179, and 214 respectively to each stage) in a total of 338 patients. A total of 290 patients are still on treatment. Most interferons (IFN) were suspended along this 9y period, independently of the stage (86.5% of first stage, 63.3% of sencond stage, and 70.6% of third stage), mainly for inefficacy. From the first stage, only 13 IFN remain active, but 6 (33.3%) of AG, and 8 (32%) of NTZ remain active. In the third stage, more than 80% DMTs remain active, except for DMF (68.9%) and IFN1A (29.4%).
Contrary to that expected, 17%, 23.91% and 35.3%, respectively of DMTs prescribed in the first, second or third stage were switched to new oral therapies. Switches from first to second line therapies decreased along this 9y period from 37.32% in the first stage, 12.29% in the second stage, and 8.87% in the third stage. The evolution of spending on these drugs has been linearly increasing during the first 7 y by 20%, afterwards it reduced to 15% in the last 2 y. Kaplan-Meyer curves demostrated that oral therapies were more persistent than injectables (log-rank p=0.001).
Conclusions: We have found that oral and second line therapies were associated with longer persistance on treatment. The use of IFN, was associated with higher probability to switch to second-line therapies.
The more persistent new oral treatments could be related to the reduction in the evolution of BI due to these drugs because of decreased switch to more expensive second-line therapies.
Disclosure: Agustin Oterino has received honoraria for speaking from Sanofi, Biogen, Teva, Merck, Almirall, Allergan,Novartis, and Roche.
David Gómez has nothing to disclose
David Cantarero has nothing to disclose
Carla Blazquez has nothing to disclose
Maria Toriello has nothing to disclose
Sara Perez has nothing to disclose
Vicente G Quintanilla has received honoraria for speaking from Novartis, and Sanofi.
This work has been funded bay Sanofi-Genzyme