DMT27
Adherence to Dmts in Patients with Multiple Sclerosis across Health-System Specialty Pharmacies
Adherence to disease-modifying therapy (DMT) for patients with multiple sclerosis (MS) can impact overall prognosis. Though DMT adherence rates have been low and variable (61-87%), health system specialty pharmacies providing comprehensive DMT management have demonstrated higher adherence, >90%, in populations using this model. . Additional data is needed to evaluate the impact of the health system specialty pharmacy model on DMT adherence.
Objectives:
To evaluate adherence to self-administered DMTs and factors associated with adherence among patients with MS treated in four health-system-owned specialty pharmacies.
Methods:
This prospective cohort study included patients diagnosed with MS who filled ≥ 3 DMT prescriptions in 12 months at one of the four participating health system specialty pharmacies from January 2020 to June 2021. Patients were excluded if they became pregnant or died during the study. De-identified pharmacy dispensing data was aggregated from each site to calculate adherence using proportion of days covered (PDC). The primary outcome was PDC, calculated as the proportion of days with medication available between the first and last fill within 12 months from the index prescription. Multiple logistic regression was used to evaluate factors associated with DMT adherence; covariates in the model included age, gender, insurance, presence of medication change, and study site.
Results:
This study included 968 patients with 10,528 prescription fills. Most patients were female (74%), with a median age of 51. Most were commercially insured (52%). The most common medications were glatiramer acetate (32%), fingolimod (18%), and dimethyl fumarate (18%). Patients had a median of 12 fills and 31 patients (3%) switched DMT during the study. Overall DMT adherence was high, with a median PDC of 97% [IQR 90%, 99%] and similar across all sites. Patients without a DMT switch were 3.8 times more likely to have a higher PDC than those who had at least one switch after adjusting for other covariates [95% CI 2.1-6.9].
Conclusions:
This multisite, prospective study affirms reports of high DMT adherence in health system specialty pharmacies. Patients who switched DMT during the study had lower adherence, indicating these patients may require close monitoring. Further research is needed to investigate the financial and clinical outcomes tied to adherence.