title: Persistence with and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis.
abstract: OBJECTIVE
  Achieving therapeutic goals in multiple sclerosis (MS) requires strict adherence to treatment schedules. This retrospective study analyzed persistence with, and adherence to, fingolimod compared with injectable/infusible disease-modifying therapies (DMTs) in patients with MS.
  
  
  METHODS
  Patients in the PharMetrics Plus™ US administrative claims database with at least one prescription for, or administration of, fingolimod, glatiramer acetate (GA), interferon (IFN), or natalizumab (index DMT) between October 1, 2010 and September 30, 2011 were included. Patients were naïve to index DMT (no claim in the previous 360 days) and had an MS diagnosis code within 360 days of the first index DMT prescription. Outcomes were persistence, risk of discontinuing index DMT (evaluated by a Cox proportional hazards model), adherence (measured using the medication possession ratio [MPR] and proportion of days covered [PDC] in patients with at least two index DMT prescriptions), and the risk of being non-adherent (MPR <80% and PDC <80%, assessed using a logistic regression model).
  
  
  RESULTS
  The study included 3750 patients (fingolimod, n = 889; GA, n = 1233; any IFN, n = 1341; natalizumab, n = 287). Discontinuation rates (fingolimod, 27.9%; GA, 39.5%; IFN, 43.7%; natalizumab, 39.5%; all p < 0.001) and risk of discontinuation were significantly higher (hazard ratios vs fingolimod [95% confidence interval]: GA, 1.75 [1.49-2.07]; IFN, 2.01 [1.71-2.37]; natalizumab, 1.53 [1.22-1.91]) for patients receiving other DMTs compared with fingolimod. The risk of being non-adherent was also lower for patients in the fingolimod cohort than the other treatment cohorts, irrespective of whether non-adherence was defined as MPR <80% (p < 0.05 for all) or PDC <80% (p < 0.05 for GA and IFN).
  
  
  CONCLUSIONS
  As with all studies assessing real-world treatment patterns it is unclear if medications were used as prescribed.
  
  
  CONCLUSIONS
  In a real-world setting, persistence with, and adherence to, oral fingolimod was higher than for injectable and infusible DMTs.
authors.affiliation: Novartis Pharma AG , Basel , Switzerland.
authors.forename: Niklas
authors.initials: N
authors.lastname: Bergvall
authors.forename: Allison A
authors.initials: AA
authors.lastname: Petrilla
authors.forename: Swapna U
authors.initials: SU
authors.lastname: Karkare
authors.forename: Raquel
authors.initials: R
authors.lastname: Lahoz
authors.forename: Neetu
authors.initials: N
authors.lastname: Agashivala
authors.forename: Ashish
authors.initials: A
authors.lastname: Pradhan
authors.forename: Gorana
authors.initials: G
authors.lastname: Capkun
authors.forename: Charles
authors.initials: C
authors.lastname: Makin
authors.forename: Catherine Balderston
authors.initials: CB
authors.lastname: McGuiness
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Korn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D004333:Drug Administration Routes; D005260:Female; D000068876:Fingolimod Hydrochloride; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab; D010455:Peptides / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011409:Propylene Glycols / Q000627:therapeutic use*; D012189:Retrospective Studies; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000069442:Natalizumab; D010455:Peptides; D011409:Propylene Glycols; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine; D000068556:Interferon beta-1a
keywords: Adherence; Fingolimod; Glatiramer acetate; Interferon; Multiple sclerosis; Natalizumab; Persistence