Treatment Discontinuation after Initiation of Oral Disease-Modifying Therapies in Patients with Multiple Sclerosis

Background: Disease-modifying therapies (DMTs) have been shown to delay progression of multiple sclerosis and reduce relapses. Little is known about treatment patterns after discontinuation of oral DMTs (ODMTs).

Objectives: To describe all DMT treatment patterns after discontinuation of ODMTs [dimethyl fumarate (DMF), teriflunomide (TFN), or fingolimod (FTY)] in patients newly initiating these agents.

Methods: AA retrospective study was conducted using Truven Health MarketScan^® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. Patients newly initiating an ODMT between 4/1/13 and 6/30/13 (first ODMT claim = index date for index DMT) who were continuously enrolled for 12 months pre- (baseline) and 12 months post- index date (follow-up) were included. Patients who experienced > 30 days with no supply of the index ODMT were assumed to have a gap in therapy (Rx gap). The last Rx gap during the follow-up was examined to gain insights into all DMT treatment patterns (switch, discontinuation, etc.).

Results: The study included 1533 DMF, 146 TFN and 196 FTY patients meeting study inclusion criteria. At the end of follow-up, 473 (30.9%) of DMF, 57 (39.0%) of TFN and 41 (20.9%) of FTY patients had an Rx gap of >30 days. In patients with a >30 day Rx gap at the end of follow-up, more than half of those on DMF (55.8%) and TFN (52.6%) discontinued DMT treatment completely (i.e. did not resume their current treatment or switch to another DMT), compared with 19.5% of those on FTY. The proportions of patients who discontinued DMTs completely by duration of discontinuation days were as follows: ≤180 days (8.0% DMF, 5.5% TFN, 2.6% FTY); 181-210 days (0.9% DMF, 2.7% TFN, 0.5% FTY); 211-365 days (8.3% DMF, 12.3% TFN, 1.0% FTY).

Conclusions: Among patients newly initiating ODMTs, those on TFN and DMF had more frequent and lengthy Rx gaps at the end of follow-up, when compared with those on FTY. Over 50% of DMF and TFN users did not restart any DMT after discontinuing their individual oral therapy during follow-up, vs. 20% of FTY users. Further exploration is needed into contributing factors, both physician- and patient-reported, such as tolerability, in order to understand differential discontinuation by ODMT and to formulate appropriate mitigation strategies.