MD10
Time Spent with Adequate Supply of Dimethyl Fumarate in a Specialty Pharmacist-Led Monitoring Program Versus Standard Dispensation in British Columbia
Dimethyl fumarate (DMF) reduces risk of relapse in relapsing multiple sclerosis (RMS). Reduced lymphocytes while taking DMF may increase risk of developing progressive multifocal leukoencephalopathy, a serious opportunistic infection. Vigilance with monitoring may be enhanced by a pharmacist-led program where pharmacists are delegated to review patient bloodwork prior to dispensation. Such programs have been shown to improve patient adherence with protective blood monitoring and may improve time spent with an adequate supply of drug.
Objectives:
To compare time spent with an adequate supply of DMF in patients using a mail-order specialty pharmacist-led program with province-wide coverage versus standard dispensation.
Methods:
This single-center observational retrospective cohort study included RMS patients treated with DMF. Age, postal code and dispensation data (dose, date of dispensation and quantity dispensed) were collected. DMF was dispensed through a specialty mail-order pharmacy with a pharmacist-led program as described above, or through a pharmacy of the patient’s choice. The primary endpoint was the percentage of time patients had an adequate supply of DMF throughout their treatment period, as measured by dispensation data. Between-group comparisons were carried out using logistic regression.
Results:
Three-hundred sixty-seven (367) patients were included in the study. Of those, 178 used the pharmacist-led program and 189 patients used standard dispensation. The average age of those receiving drug from the pharmacist-led program was 39.9 years and 43.9 years in the standard dispensation group. Patients in the pharmacist-led program and those receiving standard dispensation obtained their prescriptions on-time 68.3% and 55.2% of the time, respectively. Proportion of time spent with an adequate supply of DMF in the pharmacist-led program and those receiving standard dispensation were 94.5% and 88.5%, respectively. Patients in the pharmacist-led program had an odds ratio of 2.07 (95% CI = 1.23, 3.57; p = 0.009) for having an adequate supply of DMF compared with those receiving standard dispensation.
Conclusions:
Results indicate that the pharmacist-led program improves time spent with adequate supply of DMF. This does not guarantee that patients took medications as prescribed. Future studies include a comparison of patient adherence to bloodwork monitoring between the pharmacist-led program and standard dispensation.