title: Disease-modifying drug initiation patterns in commercially insured multiple sclerosis patients: a retrospective cohort study.
abstract: BACKGROUND
  The goal of this research was to compare the demographics, clinical characteristics and treatment patterns for newly diagnosed multiple sclerosis (MS) patients in a commercial managed care population who received disease-modifying drug (DMD) therapy versus those not receiving DMD therapy.
  
  
  METHODS
  A retrospective cohort study using US administrative healthcare claims identified individuals newly diagnosed with MS (no prior MS diagnosis 12 months prior using ICD-9-CM 340) and ≥18 years old during 2001-2007 to characterize them based on demographics, clinical characteristics, and pharmacologic therapy for one year prior to and a minimum of one year post-index. The index date was the first MS diagnosis occurring in the study period. Follow-up of subjects was done by ICD-9-CM code identification and not by actual chart review. Multivariate analyses were conducted to adjust for confounding variables.
  
  
  RESULTS
  Patients were followed for an average of 35.7±17.5 months after their index diagnosis. Forty-three percent (n=4,462) of incident patients received treatment with at least one of the DMDs during the post-index period. Treated patients were primarily in the younger age categories of 18-44 years of age, with DMD therapy initiated an average of 5.3±9.1 months after the index diagnosis. Once treatment was initiated, 27.7% discontinued DMD therapy after an average of 17.6±14.6 months, and 16.5% had treatment gaps in excess of 60 days.
  
  
  CONCLUSIONS
  Nearly 60% of newly-diagnosed MS patients in this commercial managed care population remained untreated while over a quarter of treated patients stopped therapy and one-sixth experienced treatment gaps despite the risk of disease progression or a return of pre-treatment disease activity.
authors.affiliation: Thomson Reuters, 332 Bryn Mawr Ave, Bala Cynwyd, PA 19004, USA. jay.margolis@thomsonreuters.com
authors.forename: Jay M
authors.initials: JM
authors.lastname: Margolis
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Johnson
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Kassed
authors.forename: Kristijan
authors.initials: K
authors.lastname: Kahler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003710:Demography; D061345:Early Medical Intervention / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents