Back to Journals » Patient Preference and Adherence » Volume 11

Persistence to disease-modifying therapies for multiple sclerosis in a Canadian cohort

Authors Melesse DY, Marrie RA, Blanchard JF, Yu BN, Evans C

Received 29 March 2017

Accepted for publication 9 June 2017

Published 28 June 2017 Volume 2017:11 Pages 1093—1101

DOI https://doi.org/10.2147/PPA.S138263

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 4

Editor who approved publication: Dr Johnny Chen

Dessalegn Y Melesse,1,2 Ruth Ann Marrie,2,3 James F Blanchard,1 Bo Nancy Yu,1,4 Charity Evans5

1Centre for Global Public Health, 2Department of Community Health Sciences, 3Department of Internal Medicine, University of Manitoba, 4Public Health, Manitoba Health Seniors and Active Living, Winnipeg, Manitoba, 5College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Purpose: To examine the long-term persistence to the first-line injectable disease-modifying therapies (DMTs) for multiple sclerosis (MS) and to identify the factors associated with nonpersistence.
Patients and methods: We used population-based administrative data from Manitoba, Canada. All adult subjects who were diagnosed with MS and dispensed a first-line injectable DMT (beta-interferon-1b, beta-interferon-1a, and glatiramer acetate) between 1996 and 2011 and had a minimum of 1 year of follow-up were included. The primary outcome was the median time to discontinuation of any DMT. The associations between potential predictors and persistence were estimated using multivariable Cox-proportional hazard models.
Results: Overall, 721 subjects were followed for a median of 7.8 years (interquartile range 6.1). The median time to discontinuation of all first-line DMTs was 4.2 years (25th and 75th percentile: 1.7, 10.6 years). Of the 451 (62.6%) subjects who discontinued their DMT during the study period, 259 (57.4%) eventually resumed or restarted a DMT. Subjects who were younger when starting a DMT, had prior MS-related hospitalizations, were more recently diagnosed with MS, or had a greater lag time between their MS diagnosis and DMT initiation were more likely to discontinue therapy.
Conclusion: Over half of the individuals receiving a DMT for MS in Manitoba remained on therapy for at least 4 years. DMT discontinuation occurred in 60% of the cohort, but most restarted a DMT within 1 year. While not all of the factors identified with discontinuing DMT are modifiable, they may help practitioners enhance MS care by identifying individuals who may be at particular risk for DMT discontinuation.

Keywords: drug utilization, discontinuation, adherence, administrative data

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]