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).
To compare adherence, persistence, and discontinuation in Hispanic patients with MS receiving fingolimod (FTY) versus glatiramer acetate (GA).
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).
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.
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.