DX44
Medication Prescribing Patterns Associated with Multiple Sclerosis Patients Treated with Oral Disease-Modifying Therapies
There are 3 approved MS oral disease-modifying therapies (ODMTs) in-market, i.e. dimethyl fumarate (DMF), fingolimod (FTY), and teriflunomide (TFN). Per their US package inserts, all 3 ODMTs are indicated for first-line treatment of RRMS; dose escalation (DE) is recommended only for DMF in the first month of use as 120mg twice daily (BID) for 7 days then 240mg BID thereafter, whereas FTY and TFN have no DE.
Objectives:
To provide real world insight into ODMT prescribing patterns based on a retrospective review of the medical records (MRs) of US patients with MS.
Methods:
In our study, 259 distinct medical records (MRs) of MS-diagnosed patients using ODMTs were abstracted from 19 US-based neurology clinics between 12/31/10 and 06/30/14 (DMF: 133; FTY: 67; TFN: 59). Eligible patients had ≥3 visits: 1 visit related to ODMT initiation (defined as index visit), ≥2 MS-related visits (one within the 12 months prior to and one within the 12 months following, ODMT initiation), and documented age and gender. ODMT prescribing patterns (i.e. medication switching, discontinuation, restarts, and add-ons) were tracked in the pre- and post-index windows; DE was evaluated at 1-3, 4-6, 7-9, and 10-12 month (mo) intervals, as well as cumulatively, in patients with complete follow-up.
Results:
MS-related medication switching, reduction, restarting, and add-ons were observed infrequently (each outcome identified in ≤3% within 9 months; ≤4% within 12 months) and similarly across ODMT cohorts in our study. Assessment of DE with DMF over 9 months (167 of 259 MRs) and 12 months (132 of 259 MRs) was: at 9 months (9.4% at 1-3 mo, 15.3% at 4-6 mo, 21.2% at 7-9 mo) and at 12 months (9.2% at 1-3 mo, 13.9% at 4-6 mo, 23.1% at 7-9 mo, 0% at 10-12 mo). Over 1-9 months, 45.9% of patients on DMF had DE; a similar proportion was seen over 1-12 months (46.2%).
Conclusions:
MRs provide valuable insight into important aspects of provider and patient behavior, but are subject to documentation practices. There were no observed differences in the medication prescribing patterns for ODMTs, with the exception of DE. With regards to DE, delays were observed in titration to the therapeutic dose of DMF at every interval, as well as up to 9 months after initiation. Adverse implications of a delay in DE on key disease outcomes such as prevention of relapses and slowing of disease progression, as well as associated cost, should be explored. Additional insights to support tailored prescribing of ODMT agents are needed.