SX06
Real-World Comparison of Adherence and Persistence Among African-Americans with Multiple Sclerosis Treated with Fingolimod Versus Glatiramer Acetate
Studies examining real-world adherence and persistence on disease-modifying therapies (DMTs) among African-American patients diagnosed with multiple sclerosis (MS) are scarce.
Objectives:
To compare adherence, persistence, and discontinuation between African-American patients with MS initiating therapy on fingolimod (FTY) versus glatiramer acetate (GA).
Methods:
This retrospective study used medical and pharmacy claims data and enrollment information from a large national United States health plan. African-American patients ≥18 years old initiating treatment on FTY or GA from 9/1/2010-6/30/2014 were included. The first FTY or GA claim determined the index date; patients were assigned to the FTY or GA cohort according to index DMT. Patients had continuous health plan enrollment during 6 months pre-index and 12 months post-index, ≥1 MS diagnosis (ICD-9 code 340) in the pre-index period or in the first 6 months post-index, and <25 days per hospital stay during post-index period. Outcomes were measured over the 12-month post-index period, and included adherence measured with proportion of days covered (PDC), discontinuation (≥60-day gap in index DMT), and persistence (days to first discontinuation). Outcomes were reported by DMT cohort.
Results:
Of 210 patients, 71 were in the FTY cohort and 139 in the GA cohort. FTY and GA cohorts, respectively, had similar age (mean [standard deviation (SD)]: 43.7 [10.3] vs. 42.6 [12.0] years), gender (81.7 vs. 87.8% female), ≥1 pre-index period MS relapse (31.0 vs. 31.7%), geographic region, insurance type, and index year. FTY vs. GA patients were less likely to be treatment-naïve (52.1 vs. 79.9%, respectively). The FTY cohort had greater adherence compared with GA, with mean PDC of 0.78 (95% confidence interval [CI] 0.72, 0.83) vs. 0.67 (CI: 0.63, 0.72) and 63.4% with PDC ≥0.80 (CI: 51.1, 74.5) vs. 46.0% (CI: 37.6, 54.7). FTY patients had twice the odds of PDC ≥0.80 (unadjusted odds ratio: 2.03, CI: 1.13, 3.65). The percentage discontinuing their index DMT was 28.2% for FTY and 39.6% for GA. FTY patients were persistent for mean (SD) 298.5 (109.4) days vs. GA patients (266.7 [124.1] days); the difference in mean persistence between cohorts was 31.8 days (CI: -2.6, 66.1).
Conclusions:
Similar to trends in the general MS population, African-American MS patients were significantly more adherent to FTY versus GA treatment in the real-world setting, which should be considered when discussing MS treatment options.