title: The Australian Multiple Sclerosis (MS) immunotherapy study: a prospective, multicentre study of drug utilisation using the MSBase platform.
abstract: OBJECTIVE
  To prospectively characterise treatment persistence and predictors of treatment discontinuation in an Australian relapsing-remitting multiple sclerosis (RRMS) population.
  
  
  METHODS
  Tertiary MS treatment centres participating in the MSBase registry prospectively assessed treatment utilisation, persistence, predictors of treatment discontinuation and switch rates. Multivariable survival analyses were used to compare treatment persistence between drugs and to identify predictors of treatment discontinuation.
  
  
  RESULTS
  1113 RRMS patients were studied. Patients persisted on their first disease-modifying therapy (DMT) for a median of 2.5 years. Treatment persistence on GA was shorter than on all IFNβ products (p<0.03). Younger age at treatment initiation and higher EDSS were predictive of DMT discontinuation. Patients persisted on subsequent DMTs, for 2.3 years. Patients receiving natalizumab (NAT) as a subsequent DMT persisted longer on treatment than those on IFNβ or GA (p<0.000). The primary reason for treatment discontinuation for any drug class was poor tolerability. Annualised switch or cessation rates were 9.5-12.5% for individual IFNβ products, 11.6% for GA and 4.4% for NAT.
  
  
  CONCLUSIONS
  This multicentre MS cohort study is the first to directly compare treatment persistence on IFNβ and GA to NAT. We report that treatment persistence in our Australian RRMS population is short, although patients receiving IFNβ as a first DMT persisted longer on treatment than those on GA. Additionally, patients receiving NAT as a subsequent DMT were more likely to persist on treatment than those switched to IFNβ or GA. EDSS and age at DMT initiation were predictive of DMT discontinuation. Treatment intolerance was the principal reason for treatment cessation.
authors.affiliation: Melbourne Brain Centre, RMH, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia. vilija.jokubaitis@unimelb.edu.au
authors.forename: Vilija G
authors.initials: VG
authors.lastname: Jokubaitis
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lechner-Scott
authors.forename: Michael
authors.initials: M
authors.lastname: Barnett
authors.forename: Cameron
authors.initials: C
authors.lastname: Shaw
authors.forename: Steve
authors.initials: S
authors.lastname: Vucic
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Helmut
authors.initials: H
authors.lastname: Butzkueven
authors.forename: Mark
authors.initials: M
authors.lastname: Slee
mesh_terms: D000367:Age Factors; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001315:Australia; D015331:Cohort Studies; D000068717:Glatiramer Acetate; D006801:Humans; D007167:Immunotherapy / Q000379:methods* / Q000706:statistics & numerical data*; D016899:Interferon-beta / Q000627:therapeutic use; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000276:immunology*; D000069442:Natalizumab; D010455:Peptides / Q000627:therapeutic use; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016903:Drug Monitoring
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta