Treatment discontinuation and disease progression with injectable disease-modifying therapies: findings from the north american research committee on multiple sclerosis database.
Injectable first-line disease-modifying therapies (DMTs) for multiple sclerosis (MS) are generally prescribed for continuous use. Accordingly, the various factors that influence patient persistence with treatment and that can lead some patients to switch medications or discontinue treatment may affect clinical outcomes. Using data from the North American Research Committee on Multiple Sclerosis (NARCOMS) database, this study evaluated participants' reasons for discontinuation of injectable DMTs as well as the relationship between staying on therapy and sustained patient-reported disease progression and annualized relapse rates. Participants selected their reason(s) for discontinuation from among 16 possible options covering the categories of efficacy, safety, tolerability, and burden, with multiple responses permitted. Both unadjusted data and data adjusted for baseline age, disease duration, disability, and sex were evaluated. Discontinuation profiles varied among DMTs. Participants on intramuscular interferon beta-1a (IM IFNβ-1a) and glatiramer acetate (GA) reported the fewest discontinuations based on safety concerns, although GA was associated with reports of higher burden and lower efficacy than other therapies. Difficulties with tolerability were more often reported as a reason for discontinuing subcutaneous (SC) IFNβ-1a than as a reason for discontinuing IM IFNβ-1a, GA, or SC IFNβ-1b. In the persistent therapy cohort, less patient-reported disability progression was reported with IM IFNβ-1a treatment than with SC IFNβ-1a, IFNβ-1b, or GA. These findings have relevance to clinical decision making and medication compliance in MS patient care.
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Robert J
RJ
Fox
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Amber R
AR
Salter
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Tuula
T
Tyry
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Jennifer
J
Sun
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Xiaojun
X
You
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Genevieve
G
Laforet
Mellen Center for Multiple Sclerosis, Neurological Institute, and the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (RJF); the University of Alabama at Birmingham, Birmingham, AL, USA (ARS); Barrow Neurological Institute of St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA (TT); Biogen Idec Inc, Weston, MA, USA (JS, XY, GL, DC); the University of Massachusetts Medical School, Worcester, MA, USA (GL); and the University of Arizona College of Medicine, Phoenix, AZ, USA (DC).
Denise
D
Campagnolo