SX07
Real-World Comparison of Adherence and Persistence Between Hispanic Patients with Multiple Sclerosis Initiating Fingolimod or Glatiramer Acetate
There are little real-world data on adherence and persistence of disease-modifying therapies (DMTs) among Hispanic patients diagnosed with multiple sclerosis (MS).
Objectives:
To compare adherence, persistence, and discontinuation in Hispanic patients with MS receiving fingolimod (FTY) versus glatiramer acetate (GA).
Methods:
Medical and pharmacy claims data and enrollment information from a large national United States health plan were used in this retrospective study. Hispanic patients ≥18 years old who initiated FTY or GA from 9/1/2010-6/30/2014 were identified. Index date and DMT cohorts were defined from the first FTY or GA claim. Other selection criteria were: continuous enrollment in the health plan for 6 months pre-index and 12 months post-index; ≥1 MS diagnosis (ICD-9 code 340) within 6 months before or after the index date; and no post-index hospital stays >25 days. Outcomes, measured in the 12-month post-index period and reported by DMT cohort, were adherence, measured with medication possession ratio (MPR) and proportion of days covered (PDC), discontinuation (≥60-day gap in index DMT treatment), and persistence (days to first discontinuation).
Results:
The total study population was 171 subjects, 62 and 109 in the FTY and GA cohorts, respectively. FTY and GA patients were predominantly female (79.0 and 78.9%, respectively) with similar mean (standard deviation) age of 41.9 (9.5) vs. 39.6 (10.2) years. The distributions of cohorts by insurance type, geographic region, and index year were also similar. A lower percentage of FTY patients were treatment-naïve compared with GA (46.8 vs. 85.3%). The percentages of FTY and GA patients with ≥1 MS relapse in the pre-index period were 32.3 and 25.7%, respectively. The mean PDC was higher in the FTY cohort: 0.83 (95% confidence interval [CI]: 0.79, 0.88) vs. 0.71 (CI: 0.66, 0.77); similar results were observed for MPR. The FTY vs. GA cohort had significantly greater unadjusted odds of PDC ≥ 0.80 (odds ratio (OR): 2.15; CI: 1.11, 4.18) and lower unadjusted odds of discontinuation (OR: 0.38, CI: 0.18, 0.80). Mean persistence was 329.2 (CI: 311.4, 346.9) and 275.1 (252.4, 297.7) days in the FTY and GA cohorts, respectively.
Conclusions:
This real-world analysis showed that Hispanic patients with MS who initiated treatment with FTY had higher mean adherence, less discontinuation, and longer mean persistence than those on GA treatment; these data can be considered in DMT treatment discussions.