Patient Experience and Tolerance of New Glatiramir Dosing

Background: Multiple Sclerosis (MS) Disease-Modifying Therapies (DMT)s have enabled many patients to benefit from reduced relapses, slower disease progression, and fewer brain lesions than experienced by patients not on DMTs. The number of new DMT options, both oral and injection or intravenous, has expanded in recent years. This is welcome news for both providers and persons living with MS. However, even the most efficacious DMT will not help patients if adherence is problematic or intolerable due to DMT side effects. Clinical trials may not show the extent of tolerability problems with a new DMT -- only post-market experience shows the full array of adverse effects.

We describe the experience and tolerance of a new form of glatiramir acetate in a populations of Veterans with MS in Washington State. Glatiramir, a first-line DMT, was originally approved in a 20mg dose given by daily subcutaneous injection. In 2013, the FDA approved a 40mg dose of glatiramir which required only 3 subcutaneous injections per week -- a reduction of over 50% in injection frequency from the original 7 per week regimen. It was expected that patients with MS would welcome an option which required fewer injections, and find it well-tolerated.

Objectives: 1) To understand and describe the patient experience of adherence to the 3 x week glatiramir.

2) To identify both positive and troublesome aspects of this DMT regimen, in order to intervene and manage problems which otherwise might cause patients to self-discontinue DMT.

3) To further analyze this patient-reported data for elements crucial to patient satisfaction and quality improvement. Findings will be used as we evaluate current and potential programs for ways to further improve care to Veterans with MS.

Methods: Chart reviews of Veterans with MS taking glatiramir. May also include focus groups of these Veterans taking glatiramir. 

Results: Initial findings indicate approximately 25% of patients find the 40mg dose less tolerable than the 20mg dose. Increased injection-site reactions are reported. More concerning is the incidence, although small, of systemic reactions. Data collection continues through late April/early May 2015.

Conclusions: Final results, analysis and conclusions will be presented at the CMSC 2015 Annual Meeting Poster Session on Friday, May 29, 2015.