Real world persistence of multiple sclerosis disease modifying therapies

Tallantyre, Emma C. ORCID: https://orcid.org/0000-0002-3760-6634, Dobson, Ruth, Froud, Joseph L. J., St John, Frederika A., Anderson, Valerie M., Arun, Tarunya, Buckley, Lauren, Evangelou, Nikos, Ford, Helen L., Galea, Ian, George, Sumi, Gray, Orla M., Hibbert, Aimee M., Hu, Mo, Hughes, Stella E., Ingram, Gillian, Kalra, Seema, Lim, Chia-Hui, Mathews, Joela T. M., McDonnell, Gavin V., Mescall, Naomi, Norris, Sam, Ramsay, Stephen J., Rice, Claire M., Russell, Melanie J., Shawe-Taylor, Marianne J., Williams, Thomas E., Harding, Katherine E. and Robertson, Neil P. ORCID: https://orcid.org/0000-0002-5409-4909 2024. Real world persistence of multiple sclerosis disease modifying therapies. European Journal of Neurology 31 (7) , e16289. 10.1111/ene.16289

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Abstract

Background and purpose Treatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real-world rates of persistence on disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation. Methods Treatment data on 4366 consecutive people with relapse-onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan–Meier survival analyses were used to express DMT persistence. Results In 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1–4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate. Conclusions Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Publisher:	Wiley Open Access
ISSN:	1351-5101
Date of First Compliant Deposit:	3 April 2024
Date of Acceptance:	14 March 2024
Last Modified:	04 Jul 2024 14:07
URI:	https://orca.cardiff.ac.uk/id/eprint/167347

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