Patient Perspectives on Factors Related to Medication Persistence in MS Patients Experiencing DMF-Associated Gastrointestinal Events

Background: GI adverse events (AEs) are a common reason for early therapy discontinuation in MS patients initiating treatment with delayed-release dimethyl fumarate (DMF). Patient perspectives related to persistence on therapy are important to consider in optimizing the benefits of DMF.

Objectives: To identify patient-reported approaches for improving persistence on DMF among patients with GI AEs.

Methods: An online survey was conducted Jun 30 – Aug 25, 2017 with three groups of RRMS patients: DMF users without GI AEs (n=195), DMF users with GI AEs persisting on DMF (n=103), and DMF users with GI AEs who discontinued DMF (n=88). Patients who initiated DMF after Jan 1, 2015 were included and asked about demographics, medical history, AEs type/severity, mitigation strategies, and HCP recommendations. Responses were evaluated using descriptive statistics, Chi-square test, and ANOVA.

Results: Patient groups were similar for ethnicity, BMI, treatment experience, time since MS diagnosis, prescribing HCP, and DMF treatment duration. Patients who were younger, female, and with seasonal allergies and/or GERD were more likely to report GI AEs. Consistent with DMF trials, the incidence of GI AEs was the highest within the first 3 weeks (80%-93% of patients) and decreased over time. Among patients with GI AEs, a higher proportion of those who discontinued DMF reported experiencing severe symptoms (17%-59% vs 8%-13% across symptoms) and a higher number of symptoms (mean 3.1 vs 2.8; p=.01). 

Over half of patients across study groups (57%-64%) did not recall receiving written instructions for taking DMF and managing GI AEs. Among the rest, a higher proportion of patients who persisted on DMF found written instructions that included food recommendations helpful than those who discontinued (93% vs 75%; p=.04). Only 42% to 44% of DMF users with GI AEs received recommendations for over-the counter (OTC) symptomatic therapies. Key influencers for staying on DMF despite GI AEs were identifying successful symptomatic management strategies, being informed about the likely transient nature of GI AEs, and being advised that DMF is the best treatment option for them at the time.

Conclusions: Persistence on DMF when experiencing GI AEs can be improved by effective communication with an HCP, including a rationale for therapy selection, expectation setting on the duration of GI events, written instructions that include food recommendations, and appropriate symptomatic management.

Supported by: Biogen