1
|
Neter E, Esterkin-Hubner E, Glass-Marmor L, Wolkowitz A, Lavi I, Miller A. Personalized Intervention to Improve Medication Adherence for Persons with Multiple Sclerosis. Patient Prefer Adherence 2024; 18:1195-1203. [PMID: 38895639 PMCID: PMC11182877 DOI: 10.2147/ppa.s455518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose To evaluate the acceptability, retention, and efficacy of face-to-face intervention, incorporating education and Motivational Interviewing (MI) to support persons with relapsing-remitting multiple sclerosis (PwRRMS) and increase self-reported medication adherence. Patients and Methods PwRRMS (N = 60) prescribed Disease Modifying Treatment (DMT), who were identified as non-adherent and consented to participate in an intervention, received verbal education and counseling from their treating physician, a tailored MI counseling and a booster session via telephone with a health psychologist, and a concluding MI counseling six months later. Each PwRRMS filled a battery of patient-reported outcomes (PROs) at baseline, six and 12 months later. The design was a quasi-experimental pre-test post-test across a year. Results Of the sixty identified persons who consented to enroll, 52 completed the intervention and 46 completed the follow-up. At six months following the baseline, adherence scores increased (median = 12.0) and were significantly different than at baseline (median=10.0, p = 0.030). Still, at 12 months follow-up there was no significant difference from baseline in reported adherence (median = 11.0, p = 0.106). Conclusion This study demonstrated reasonable retention and initial efficacy of a combined psycho-education and MI protocol for PwRRMS to enhance medication adherence to DMT. To maintain the change, a more sustained intervention is required.
Collapse
Affiliation(s)
| | - Efrat Esterkin-Hubner
- Multiple Sclerosis Center & Department of Neurology,Carmel Medical Center, Haifa, Israel
| | - Lea Glass-Marmor
- Multiple Sclerosis Center & Department of Neurology,Carmel Medical Center, Haifa, Israel
| | - Anat Wolkowitz
- Multiple Sclerosis Center & Department of Neurology,Carmel Medical Center, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Ariel Miller
- Multiple Sclerosis Center & Department of Neurology,Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| |
Collapse
|
2
|
Singer BA, Feng J, Chiong-Rivero H. Early use of high-efficacy therapies in multiple sclerosis in the United States: benefits, barriers, and strategies for encouraging adoption. J Neurol 2024; 271:3116-3130. [PMID: 38615277 PMCID: PMC11136864 DOI: 10.1007/s00415-024-12305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
Multiple sclerosis (MS) is characterized by progressive neuroinflammation and neurodegeneration from disease onset that, if left untreated, can result in the accumulation of irreversible neurological disability. Early intervention with high-efficacy therapies (HETs) is increasingly recognized as the best strategy to delay or mitigate disease progression from the earliest stages of the disease and to prevent long-term neurodegeneration. Although there is growing clinical and real-world evidence supporting early HET intervention, foregoing this strategy in favor of a traditional escalation approach prioritizing lower-efficacy disease-modifying therapies remains a common approach in clinical practice. This review explores potential health care professional- and patient-related barriers to the early use of HETs in patients with MS in the United States. Barriers can include regulatory and reimbursement restrictions; knowledge gaps and long-term safety concerns among health care professionals; and various individual, cultural, and societal factors affecting patients. Potential strategies for overcoming these barriers and encouraging early HET use are proposed.
Collapse
Affiliation(s)
- Barry A Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, St Louis, MO, USA.
| | - Jenny Feng
- Ochsner Medical Center, New Orleans, LA, USA
| | | |
Collapse
|
3
|
Ben-Zacharia AB, Walker B, Ross AP, Tornatore C, Edwards NC, Lipman Y, Phillips AL. Factors Associated With Disease-Modifying Therapy Adherence and Persistence in Multiple Sclerosis: A Scoping Literature Review. Int J MS Care 2023; 25:188-195. [PMID: 37720259 PMCID: PMC10503813 DOI: 10.7224/1537-2073.2021-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) receiving disease-modifying therapies (DMT) show published adherence rates of 27.0% to 93.8% and published persistence rates of 49.7% to 96.5%. Improvements in DMT adherence and persistence are key to optimizing MS care, and enhanced understanding could improve MS disease management and identify research gaps. This scoping literature review aims to examine the nature and findings of the literature evaluating factors associated with DMT adherence and persistence in patients with MS. METHODS Eligible articles included in the literature review were quantitative clinical studies written in English, included adherence or persistence as primary outcomes, and accounted for covariates/confounders. The articles were assessed to identify factors associated with adherence/persistence and analyzed according to DMT type (self-injectable, oral, infusion). RESULTS Fifty-eight studies (103,450 patients) were included. Study distribution by DMT type was self-injectable only (n = 41), oral only (n = 2), infusion only (n = 1), and more than 1 type (n = 14). Older age and previous DMT use were associated with increased adherence and/or persistence. Increased alcohol consumption, DMT adverse events, higher education, and higher body mass index were negatively associated with adherence and/or persistence. Greater number and severity of relapses was associated with increased adherence but decreased persistence. CONCLUSIONS Most studies examined factors associated with adherence and persistence to self-injectable DMTs. These factors should be evaluated further for oral and infusion DMTs. Insights into the modifiable factors associated with adherence and persistence could guide treatment decisions and help improve adherence and clinical outcomes.
Collapse
Affiliation(s)
- Aliza Bitton Ben-Zacharia
- From Bellevue School of Nursing, Hunter College, New York, NY, USA (AB-Z)
- Mount Sinai Medical Center, New York, NY, USA (AB-Z)
| | - Bryan Walker
- Duke University School of Medicine, Durham, NC, USA (BW)
| | | | - Carlo Tornatore
- Medstar Georgetown University Hospital, Washington, DC, USA (CT)
| | | | | | | |
Collapse
|
4
|
Neter E, Miller A. Using an Intervention Mapping Approach to Improve Adherence to Disease-Modifying Treatment in Multiple Sclerosis. Int J MS Care 2023; 25:206-213. [PMID: 37720261 PMCID: PMC10503812 DOI: 10.7224/1537-2073.2022-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Up to 50% of individuals with multiple sclerosis (MS) who are prescribed disease-modifying treatments (DMTs) do not take them as advised. Although many studies report on DMT adherence rate, few studies report on interventions involving individuals with MS. The current paper describes the development of an intervention aimed at improving adherence to DMTs among identified nonadherent individuals with MS. METHODS An intervention was developed using an Intervention Mapping approach, recommendations from reviews on medication adherence, and input from individuals with MS. Its content was determined by theories of health behavior (specifically, a perceptions and practicalities approach), empirical evidence collected among the specific target population (an observational "needs assessment" stage [n = 186]), and other studies. RESULTS A personalized intervention was tailored to the reasons for nonadherence, uncovered during the observational needs assessment stage, to be delivered sequentially by a neurologist and a psychologist. After the intervention objectives were identified, components of the intervention were set: psychoeducation and ways of coping with adverse effects; modification of unhelpful treatment beliefs (such modifications were found predictive of adherence in the observational phase of the study); improving confidence and self-efficacy; and developing strategies for remembering to take DMTs. These components were embedded within motivational interviewing. CONCLUSIONS Intervention Mapping was useful in developing an intervention grounded both in the theoretical approach of perceptions and practicalities and in empirical evidence from the literature and the target sample; concurrently, identifying determinants that the intervention did not address. The effectiveness of the intervention-which could potentially improve adherence among individuals with MS-needs to be examined.
Collapse
Affiliation(s)
- Efrat Neter
- From the Behavioral Sciences Department, Ruppin Academic Center, Emeq Hefer, Israel (EN)
- Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel (EN)
| | - Ariel Miller
- Multiple Sclerosis Center and Neuroimmunology Unit, Carmel Medical Center, Haifa, Israel (AM)
| |
Collapse
|
5
|
Araujo L, Kyatham S, Bzdek KG, Higuchi K, Greene N. Assessing the Health Economic Outcomes from Commercially Insured Relapsing Multiple Sclerosis Patients Who Switched from Other Disease-Modifying Therapies to Teriflunomide, in the United States. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:361-373. [PMID: 37234086 PMCID: PMC10208242 DOI: 10.2147/ceor.s401687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Assess patient characteristics, healthcare resource utilization (HCRU), and relapses in patients with multiple sclerosis (MS) who switched to teriflunomide from other disease-modifying therapies (DMTs). Methods Retrospective study of US Merative™ MarketScan® claims database (Jan 1, 2012-July 31, 2020,) including HIPAA-compliant, deidentified data. Patients ≥18 years with MS diagnosis (based on ICD-9/ICD-10 codes), receiving ≥1 DMT prior to teriflunomide and ≥12 months continuous enrollment pre and post index (date of teriflunomide initiation). Outcomes included inpatient and emergency room claims coinciding with MS diagnosis, MS-related healthcare costs, and annualized relapse rates (ARRs) (indirectly assessed using hospitalization/outpatient claims and steroid use coinciding with MS diagnosis). Results The analyzed cohort (N=2016) was primarily female (79%); age (mean ± standard deviation) 51.4 ± 9.3 years; MS duration 4.7±2.8 years (at index). The majority (89.2%) were treated with one DMT before switching to teriflunomide. Use of outpatient services (event rate/100 person-years) increased post vs pre index; however, MRI visits significantly reduced over the same period (both P<0.0001). Costs for MS-specific outpatient visits decreased by $371 per patient per year (PPPY) after switching to teriflunomide. Despite an increase in use post index (0.024 to 0.033 rate/100 person-years; P<0.0001), costs for MS-specific laboratory services reduced (pre-index: $271 vs $248 PPPY post-index; P=0.02). Fewer patients had relapses after switching (pre-index: n=417 [20.7%]; post-index: n=333 [16.5%]). ARR was significantly lower after switching (pre-index: 0.269 vs post-index: 0.205; P=0.000). Conclusion Switching to teriflunomide from existing DMTs in patients with relapsing MS resulted in a reduction in outpatient HCRU in this analysis of US claims data. The real-world effectiveness of teriflunomide was generally consistent with efficacy reported in clinical trials, showing a reduction in relapse following a switch to teriflunomide.
Collapse
Affiliation(s)
- Lita Araujo
- Neurology and Immunology, Sanofi, Cambridge, MA, USA
| | | | | | - Keiko Higuchi
- Neurology and Immunology, Sanofi, Cambridge, MA, USA
| | - Nupur Greene
- Neurology and Immunology, Sanofi, Cambridge, MA, USA
| |
Collapse
|
6
|
Lager B, Liseno J, Božin I, England SM, Shankar SL, Mendoza JP, Lewin JB. Real-World Analysis Affirms the High Persistence and Adherence Observed with Diroximel Fumarate in Patients with Multiple Sclerosis. Neurol Ther 2023; 12:145-159. [PMID: 36334241 PMCID: PMC9837354 DOI: 10.1007/s40120-022-00413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Adherence to disease-modifying therapies is key for achieving optimal outcomes in multiple sclerosis (MS). Diroximel fumarate (DRF) is an oral fumarate approved for treatment of relapsing forms of MS. It has the same pharmacologically active metabolite as dimethyl fumarate (DMF) and similar efficacy and safety profiles, but with demonstrated fewer gastrointestinal (GI) related adverse events (AEs). There are limited data characterizing persistence and adherence to DRF in the real world. METHODS This retrospective analysis of the AcariaHealth Specialty Pharmacy Program included patients with MS initiating DRF from 1 December 2019 to 30 January 2021. This analysis evaluated persistence, measured as proportion of patients remaining on therapy; discontinuation rate due to GI AEs; and adherence measured by proportion of days covered (PDC). RESULTS Overall, 1143 patients were included; 433 (37.9%) patients had been treated with prior DMF and switched to DRF. Persistence was high in both groups: the estimated proportion of patients remaining on DRF at 16 months was 82.3% [95% confidence internal (CI) 77.2-86.3%], and 90.1% (95% CI 82.2-94.6%) in the DMF to DRF group. Fifty-two (4.5%) patients overall and 15 (3.5%) in the DMF switch subgroup discontinued DRF due to GI AEs. Mean PDC was 90.8% (95% CI 89.2-92.5%), and 85.4% (95% CI 83.3-87.4%) of patients achieved PDC ≥ 80% in the overall population. In the DMF to DRF group, mean PDC was 90.7% (95% CI 88.0-93.5%), and 84.8% (95% CI 81.4-88.1%) of patients achieved PDC ≥ 80%. CONCLUSION In this analysis of > 1000 patients treated with DRF in real-world clinical practice, overall persistence at 16 months was high, treatment discontinuation due to GI AEs was low, and patients were highly adherent to therapy. Of 433 patients who switched from DMF to DRF, most (> 90%) were able to tolerate and persist on DRF after switching. Graphical abstract available for this article.
Collapse
|
7
|
de Sá J, Ferreira J, Macedo AM. [Actual adherence to dimethyl fumarate in patients with relapsing-remitting multiple sclerosis]. Rev Neurol 2023; 76:S1-S6. [PMID: 36683265 PMCID: PMC10478096 DOI: 10.33588/rn.76s01.2022296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Multiple sclerosis is a chronic neurological disease with numerous disease-modifying treatments available, including dimethyl fumarate (DMF), a first-line therapy for relapsing-remitting multiple sclerosis. Although rates of discontinuation of DMF are generally low in clinical trials, non-adherence to treatment is associated with poorer clinical outcomes. Assessing real-world adherence and predictive factors is critical to be able to improve clinical outcomes for patients. This study evaluated adherence to DMF over 24 months in a cohort of patients treated in a Portuguese healthcare centre. PATIENTS AND METHODS A prospective, non-interventional, single-centre study with 24 months' follow-up was conducted. The study included adult patients with relapsing-remitting multiple sclerosis treated with DMF in routine clinical practice. Adherence to DMF was calculated and patients were considered to have adhered if the value was above 80%. Clinical and socio-demographic variables were compared between groups. RESULTS Of the 80 patients included, 74% were women, with a mean age of 39 years and a mean age of 32 years at diagnosis. Twenty-six patients had not received any previous treatment. Adherence varied between 93, 82 and 87.5% at 6, 12 and 24 months, respectively. No differences were found between patients who had not received any prior treatment and those who had been treated. CONCLUSION This real-world analysis showed significant adherence to DMF treatment by Portuguese patients over a period of two years. However, these results must be interpreted in the light of the substantial changes in outpatient consultations and the various periodic restrictions due to the COVID-19 pandemic, which had an important effect on patient follow-up and data collection.
Collapse
Affiliation(s)
- João de Sá
- Hospital de Santa Maria. Centro hospitalario Lisboa Norte. LisboaHospital de Santa MariaHospital de Santa MariaLisboaPortugal
| | - João Ferreira
- Hospital de Santa Maria. Centro hospitalario Lisboa Norte. LisboaHospital de Santa MariaHospital de Santa MariaLisboaPortugal
| | - Ana M. Macedo
- Facultad de Medicina y Ciencias Biomédicas. Universidad del Algarve. Algarve, PortugalUniversidad del AlgarveUniversidad del AlgarveAlgarvePortugal
| |
Collapse
|
8
|
Choudhary D, Thomas M, Pacheco-Barrios K, Zhang Y, Alonso-Coello P, Schünemann H, Hazlewood G. Methods to Summarize Discrete-Choice Experiments in a Systematic Review: A Scoping Review. THE PATIENT 2022; 15:629-639. [PMID: 35829927 DOI: 10.1007/s40271-022-00587-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Systematic reviews of discrete-choice experiments (DCEs) are being increasingly conducted. The objective of this scoping review was to identify and describe the methodologies that have been used to summarize results across DCEs. METHODS We searched the electronic databases MEDLINE and EMBASE from inception to March 18, 2021, to identify English-language systematic reviews of patient preferences that included at least two DCEs and extracted data on attribute importance. The methods used to summarize results across DCEs were classified into narrative, semi-quantitative, and quantitative (meta-analytic) approaches and compared. Approaches to characterize the extent of preference heterogeneity were also described. RESULTS From 7362 unique records, we identified 54 eligible reviews from 2010 to Mar 2021, across a broad range of health conditions. Most (83%) used a narrative approach to summarize findings of DCEs, often citing differences in studies as the reason for not formally pooling findings. Semi-quantitative approaches included summarizing the frequency of the most important attributes, the frequency of attribute statistical significance, or tabulated comparisons of attribute importance for each pair of attributes. One review conducted a meta-analysis using the maximum acceptable risk. While reviews often commented on the heterogeneity of patient preferences, few (6%) addressed this systematically across studies. CONCLUSION While not commonly used, several semi-quantitative and one quantitative approach for synthesizing results of DCEs were identified, which may be useful for generating summary estimates across DCEs when appropriate. Further work is needed to assess the validity and usefulness of these approaches.
Collapse
Affiliation(s)
- Daksh Choudhary
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Megan Thomas
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Sintesis de Evidencias en Salud, Lima, Peru
| | - Yuan Zhang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Instituto de Investigación Biomédica (IIB Sant Pau), Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Glen Hazlewood
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
9
|
Simoens S. Societal economic burden of multiple sclerosis and cost-effectiveness of disease-modifying therapies. Front Neurol 2022; 13:1015256. [PMID: 36341111 PMCID: PMC9631775 DOI: 10.3389/fneur.2022.1015256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background In an era of scarce resources, policy makers, neurologists and other stakeholders need to be aware of the economic burden of multiple sclerosis and the cost-effectiveness of disease-modifying therapies. The aim of this article is to provide a mini-review of these health economic facets of multiple sclerosis. Methods An umbrella review was conducted by searching PubMed and Google Scholar from 2002 until June 2022 for peer-reviewed systematic and narrative literature reviews. Results An extensive body of evidence corroborates that multiple sclerosis is associated with a substantial economic burden within and outside the health care sector, that costs of secondary progressive multiple sclerosis exceed those of relapsing-remitting multiple sclerosis, that costs increase with disease severity and are influenced by the occurrence of relapses and therapy adherence. However, cost estimates and their breakdown into various components vary between countries. Economic evaluations show that disease-modifying therapies for relapsing-remitting multiple sclerosis are generally not cost-effective, but these results depend on the local setting. Cost-effectiveness of disease-modifying therapies improves when a societal perspective is taken and efficacy does not wane over a lifetime horizon, when oral administration forms or dosing strategies requiring less maintenance are introduced, and when generic versions enter the market. Reimbursement recommendations related to disease-modifying therapies also differ between countries. Conclusion The local context matters when calculating the societal economic burden of multiple sclerosis and the cost-effectiveness of disease-modifying therapies.
Collapse
|
10
|
Lehnert T, Röver C, Köpke S, Rio J, Chard D, Fittipaldo AV, Friede T, Heesen C, Rahn AC. Immunotherapy for people with clinically isolated syndrome or relapsing-remitting multiple sclerosis: treatment response by demographic, clinical, and biomarker subgroups (PROMISE)-a systematic review protocol. Syst Rev 2022; 11:134. [PMID: 35778721 PMCID: PMC9250266 DOI: 10.1186/s13643-022-01997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system with an increasing worldwide prevalence. Since 1993, more than 15 disease-modifying immunotherapies (DMTs) have been licenced and have shown moderate efficacy in clinical trials. Based on the heterogeneity of the disease and the partial effectiveness of therapies, a personalised medicine approach would be valuable taking individual prognosis and suitability of a chosen therapy into account to gain the best possible treatment effect. The primary objective of this review is to assess the differential treatment effects of all approved DMTs in subgroups of adults with clinically isolated syndrome or relapsing forms of MS. We will analyse possible treatment effect modifiers (TEM) defined by baseline demographic characteristics (gender, age), and diagnostic (i.e. MRI measures) and clinical (i.e. relapses, disability level) measures of MS disease activity. METHODS We will include all published and accessible unpublished primary and secondary analyses of randomised controlled trials (RCTs) with a follow-up of at least 12 months investigating the efficacy of at least one approved DMT, with placebo or other approved DMTs as control intervention(s) in subgroups of trial participants. As the primary outcome, we will address disability as defined by the Expanded Disability Status Scale or multiple sclerosis functional composite scores followed by relapse frequency, quality of life measures, and side effects. MRI data will be analysed as secondary outcomes. MEDLINE, EMBASE, CINAHL, LILACS, CENTRAL and major trial registers will be searched for suitable studies. Titles and abstracts and full texts will be screened by two persons independently using Covidence. The risk of bias will be analysed based on the Cochrane "Risk of Bias 2" tool, and the certainty of evidence will be assessed using GRADE. Treatment effects will be reported as rate ratio or odds ratio. Primary analyses will follow the intention-to-treat principle. Meta-analyses will be carried out using random-effects models. DISCUSSION Given that individual patient data from clinical studies are often not available, the review will allow to analyse the evidence on TEM in MS immunotherapy and thus support clinical decision making in individual cases. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021279665 .
Collapse
Affiliation(s)
- Thomas Lehnert
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jordi Rio
- Neurology/Neuroimmunology, Centre d'Esclerosi Multiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Declan Chard
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Andrea V Fittipaldo
- Department of Oncology, Istituto Ricerche Farmacologiche "Mario Negri" IRCCS, Milano, Italy
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany. .,Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany.
| |
Collapse
|
11
|
Weber MS, Buttmann M, Meuth SG, Dirks P, Muros-Le Rouzic E, Eggebrecht JC, Hieke-Schulz S, Leemhuis J, Ziemssen T. Safety, Adherence and Persistence in a Real-World Cohort of German MS Patients Newly Treated With Ocrelizumab: First Insights From the CONFIDENCE Study. Front Neurol 2022; 13:863105. [PMID: 35614917 PMCID: PMC9126090 DOI: 10.3389/fneur.2022.863105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Real-world relapsing multiple sclerosis (RMS) and primary progressive MS (PPMS) populations may be more diverse than in clinical trials. Here, we present a first analysis of safety, adherence and persistence data from a real-world cohort of patients newly treated with ocrelizumab. Methods CONFIDENCE (ML39632, EUPAS22951) is an ongoing multicenter, non-interventional post authorization safety study assessing patients with RMS or PPMS newly treated with ocrelizumab or other disease-modifying therapies for up to 10 years. For this analysis, patients newly treated with ocrelizumab were analyzed in subgroups by MS phenotype and age over a mean ~1 year of exposure totaling 2,329 patient years [PY]). Results At data cutoff (14 October 2020), 1,702 patients with RMS and 398 patients with PPMS were treated with ≥1 dose of ocrelizumab. At baseline, the mean ages (SD) of patients with RMS and PPMS were 41.59 (11.24) and 50.95 (9.88) years and the mean EDSS (Expanded Disability Status Scale) was 3.18 (1.87) and 4.41 (1.59), respectively. The most common adverse events (AEs) and serious AEs across both phenotypes were infections and infestations, with infection SAE rates of 2.8 events/100 PY and 1.5 events/100 PY in patients with RMS and PPMS, respectively. Across all phenotypes, ocrelizumab persistence was 92% at 24 months; median time between doses was ~6 months. Conclusions The ocrelizumab safety profile observed in the CONFIDENCE real-world MS population was consistent to the one observed in pivotal clinical trials. High treatment persistence and adherence were observed. Trial Registration ML39632, EUPAS22951
Collapse
Affiliation(s)
- Martin S Weber
- Department of Neurology, Institute of Neuropathology, University Medicine Göttingen, Göttingen, Germany.,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany
| | | | - Sven G Meuth
- Clinic of Neurology, Heinrich-Heine University, Düsseldorf, Germany
| | - Petra Dirks
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, Carl Gustav Carus University Clinic, University of Technology, Dresden, Germany
| |
Collapse
|
12
|
Masri HE, McGuire TM, Dalais C, van Driel M, Benham H, Hollingworth SA. Patient-based benefit-risk assessment of medicines: development, refinement, and validation of a content search strategy to retrieve relevant studies. J Med Libr Assoc 2022; 110:185-204. [PMID: 35440905 PMCID: PMC9014953 DOI: 10.5195/jmla.2022.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Poor indexing and inconsistent use of terms and keywords may prevent efficient retrieval of studies on the patient-based benefit-risk assessment (BRA) of medicines. We aimed to develop and validate an objectively derived content search strategy containing generic search terms that can be adapted for any search for evidence on patient-based BRA of medicines for any therapeutic area. Methods: We used a robust multistep process to develop and validate the content search strategy: (1) we developed a bank of search terms derived from screening studies on patient-based BRA of medicines in various therapeutic areas, (2) we refined the proposed content search strategy through an iterative process of testing sensitivity and precision of search terms, and (3) we validated the final search strategy in PubMed by firstly using multiple sclerosis as a case condition and secondly computing its relative performance versus a published systematic review on patient-based BRA of medicines in rheumatoid arthritis. Results: We conceptualized a final search strategy to retrieve studies on patient-based BRA containing generic search terms grouped into two domains, namely the patient and the BRA of medicines (sensitivity 84%, specificity 99.4%, precision 20.7%). The relative performance of the content search strategy was 85.7% compared with a search from a published systematic review of patient preferences in the treatment of rheumatoid arthritis. We also developed a more extended filter, with a relative performance of 93.3% when compared with a search from a published systematic review of patient preferences in lung cancer.
Collapse
Affiliation(s)
- Hiba El Masri
- , PhD Candidate, School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Treasure M McGuire
- , Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia, Mater Pharmacy, Mater Health, Raymond Tce, South Brisbane, QLD, Australia
| | - Christine Dalais
- , University Library, The University of Queensland, Brisbane, QLD, Australia
| | - Mieke van Driel
- , Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Benham
- , Department of Rheumatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | |
Collapse
|
13
|
Liseno J, Lager B, Miller C, Shankar SL, Mendoza JP, Lewin JB. Multiple Sclerosis Patients Treated With Diroximel Fumarate in the Real-World Setting Have High Rates of Persistence and Adherence. Neurol Ther 2021; 10:349-360. [PMID: 33846959 PMCID: PMC8140165 DOI: 10.1007/s40120-021-00242-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Persistence to multiple sclerosis (MS) disease-modifying therapy is fundamental for maximal treatment outcomes. Diroximel fumarate (DRF) is approved in the USA for relapsing MS. Following oral administration, DRF is metabolized to monomethyl fumarate, the active metabolite of dimethyl fumarate (DMF). DRF showed clinically significant improvements in gastrointestinal (GI) tolerability versus DMF in a head-to-head clinical trial; however, real-world persistence/adherence has not been assessed. We evaluated persistence/adherence in DRF-treated patients in a real-world clinical practice. Methods This retrospective analysis of the AcariaHealth Specialty Pharmacy Program included patients initiating DRF from 4 December 2019 through 3 April 2020 and followed until data extraction (31 August 2020). Exclusion criteria included undetermined treatment status (e.g., DRF prescription transfer to a different pharmacy). Endpoints included persistence (overall proportion of patients remaining on DRF), discontinuation rate due to GI adverse events (AEs), and adherence (proportion of days covered [PDC]). GI AEs included GI-related AEs occurring at any time, or any unknown AE without details about the nature of the event if the unknown AE occurred ≤ 90 days after DRF initiation. Results Overall, 160 patients with MS were included. Median (range) patient age was 51 (20−79) years, 80.6% (129/160) of patients were female, and 16.3% (26/160) had prior DMF treatment. Median (range) treatment duration was 7.6 (0.1−10.4) months. Estimated proportion of patients remaining persistent on DRF treatment at 8 months was 88.6% (95% confidence interval [CI] 82.5–2.7). Overall, 3.8% (6/160) of patients discontinued due to GI AEs. Mean PDC was 91.4% (95% CI 89.1−93.7). In a DMF-to-DRF switch subgroup, 92.3% (24/26) remained persistent on DRF, and 3.8% (1/26) discontinued DRF due to GI AEs. Conclusion This real-world analysis of DRF-treated patients showed high overall persistence, low discontinuation rate due to GI AEs, and high adherence to therapy, aligning with expectations based on DRF clinical trials. Data were consistent in the DMF-to-DRF subgroup. Infographic ![]()
Collapse
|
14
|
Wundes A, Wray S, Gold R, Singer BA, Jasinska E, Ziemssen T, de Seze J, Repovic P, Chen H, Hanna J, Messer J, Miller C, Naismith RT. Improved gastrointestinal profile with diroximel fumarate is associated with a positive impact on quality of life compared with dimethyl fumarate: results from the randomized, double-blind, phase III EVOLVE-MS-2 study. Ther Adv Neurol Disord 2021; 14:1756286421993999. [PMID: 33796143 PMCID: PMC7985943 DOI: 10.1177/1756286421993999] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Diroximel fumarate (DRF) is a novel oral fumarate approved for relapsing forms of multiple sclerosis (MS). DRF demonstrated significantly improved gastrointestinal (GI) tolerability versus dimethyl fumarate (DMF) with fewer days of Individual Gastrointestinal Symptom and Impact Scale (IGISIS) scores ⩾2, GI adverse events (AEs), and treatment discontinuations due to GI AEs. Our aim was to evaluate the impact of GI tolerability events on quality of life (QoL) for patients with relapsing–remitting MS who received DRF or DMF in EVOLVE-MS-2. Methods: A post hoc analysis was conducted in patients who were enrolled in the randomized, blinded, 5-week, EVOLVE-MS-2 [ClinicalTrials.gov identifier: NCT03093324] study of DRF versus DMF. Patients completed daily IGISIS and Global GISIS (GGISIS) eDiary questionnaires to assess GI symptom intensity and interference with daily activities and work. Results: In total, 504 patients (DRF, n = 253; DMF, n = 251) received study drug and 502 (DRF, n = 253; DMF, n = 249) completed at least one post-baseline questionnaire. With DRF, GI symptoms were less likely to interfere ‘quite a bit’ or ‘extremely’ with regular daily activities [IGISIS: DRF, 9.5% (24/253) versus DMF, 28.9% (72/249)] or work productivity [GGISIS: DRF, 6.1% (10/165) versus DMF, 11.3% (18/159)]. DRF-treated patients had fewer days with ⩾1 h of missed work (DRF, 43 days, n = 20 versus DMF, 88 days, n = 26). DMF-treated patients reported highest GI symptom severity and missed work at week 2–3 shortly after completing the titration period, which coincided with the majority of GI-related treatment discontinuations [58.3% (7/12)]. GI tolerability AEs [DRF, 34.8% (88/253); DMF, 48.2% (121/251)], concomitant symptomatic medication use [DRF, 19.3% (17/88) versus DMF, 30.6% (37/121)], and GI-related discontinuations (DRF, 0.8% versus DMF, 4.8%) were lower with DRF versus DMF. Conclusions: The improved GI tolerability with DRF translated into clinically meaningful benefits to QoL, as patients experienced less impact on daily life and work and required less concomitant symptomatic medication use. Trial registration: [ClinicalTrials.gov identifier: NCT03093324]
Collapse
Affiliation(s)
- Annette Wundes
- Department of Neurology, University of Washington Medical Center, Seattle, WA, USA
| | - Sibyl Wray
- Hope Neurology MS Center, Knoxville, TN, USA
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barry A Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, St. Louis, MO, USA
| | - Elzbieta Jasinska
- Collegium Medicum UJK and Clinical Center, RESMEDICA, Kielce, Poland
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Jerome de Seze
- Strasbourg University Hospital and Clinical Investigation Center, INSER 1434, Strasbourg, France
| | - Pavle Repovic
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | | | | | - Jordan Messer
- Biogen, 225 Binney Street, Cambridge, MA 02142-1031, USA
| | | | | |
Collapse
|
15
|
Lavan R, Normile D, Armstrong R, Vaala W. Flea and tick treatment satisfaction, preference, and adherence of US cat owners prescribed topical fluralaner (Bravecto ® Topical Solution for Cats). Open Vet J 2021; 11:80-88. [PMID: 33898287 PMCID: PMC8057215 DOI: 10.4314/ovj.v11i1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Fluralaner is a novel isoxazoline compound and the only systemically distributed ectoparasiticide approved in the United States for redosing at up to 12-week intervals for flea and tick control in cats. Other feline ectoparasiticides, including other systemic isoxazolines, are approved for redosing at monthly intervals. A survey developed in 2016 to assess the satisfaction, preference, and adherence of dog owners prescribed fluralaner as an ectoparasiticide with the treatment and veterinary flea and tick protection recommendations was adapted for completion by cat owners in the USA. Aim: The study objective was to use cat-owner survey data obtained at US veterinary practices to assess client satisfaction and utilization practices for fluralaner, and to evaluate owner adherence to current flea and tick control recommendations. Methods: US veterinary practices (n = 26) were asked to obtain completed surveys for up to 25 active clients who were currently treating their cats with a topical preparation of fluralaner for flea and tick control. Clients who had previously used flea and tick products for cats other than fluralaner were enrolled in the study. Participating cat owners completed an 11-question survey on their satisfaction with, preference for, and adherence to treatment recommendations for topically applied fluralaner as a feline flea and tick control medication. Results: The average cat in this study had a mean (± SD) body weight of 5.1 (± 0.9) kg and was 7.1 (±1.4) years old. Most cats lived in a home versus an apartment and more than half spent some time outside. Satisfaction was assessed with a 5-point Likert scale, with nearly all cat owners (97%) indicating that they were satisfied or very satisfied with fluralaner. Most of them (66%) had previously used other monthly flea and tick products for cats. Owners were not excluded if they had previously used a canine flea and tick product. The extended dosing interval up to 12 weeks was the most frequently selected benefit of fluralaner. Nearly 9 out of 10 respondents indicated they readministered fluralaner mostly on time or delayed by a few days, and most said they were more likely to give a repeat dose of fluralaner at the recommended redosing interval compared to monthly products. 87% of the responding cat owners preferred topical fluralaner over the monthly flea and tick products they had used. Conclusion: The extended dosing interval of up to 12 weeks was the leading preference factor and the key driver of user satisfaction with fluralaner leading to improved adherence to redosing recommendations. Cat owners said they were more likely to administer fluralaner at the recommended redosing interval compared to monthly products, indicating that less frequent redosing contributes to improved adherence.
Collapse
Affiliation(s)
- Robert Lavan
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Rob Armstrong
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, USA
| | - Wendy Vaala
- Merck Animal Health, 2 Giralda Farms, Madison, NJ, USA
| |
Collapse
|
16
|
Nicholas JA, Edwards NC, Edwards RA, Dellarole A, Grosso M, Phillips AL. Real-world adherence to, and persistence with, once- and twice-daily oral disease-modifying drugs in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurol 2020; 20:281. [PMID: 32664928 PMCID: PMC7371467 DOI: 10.1186/s12883-020-01830-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonadherence to disease-modifying drugs (DMDs) for multiple sclerosis (MS) is associated with poorer clinical outcomes, including higher rates of relapse and disease progression, and higher medical resource use. A systematic review and quantification of adherence and persistence with oral DMDs would help clarify the extent of nonadherence and nonpersistence in patients with MS to help prescribers make informed treatment plans and optimize patient care. The objectives were to: 1) conduct a systematic literature review to assess the availability and variability of oral DMD adherence and/or persistence rates across 'real-world' data sources; and 2) conduct meta-analyses of the rates of adherence and persistence for once- and twice-daily oral DMDs in patients with MS using real-world data. METHODS A systematic review of studies published between January 2010 and April 2018 in the PubMed database was performed. Only studies assessing once- and twice-daily oral DMDs were available for inclusion in the analysis. Study quality was evaluated using a modified version of the Newcastle-Ottawa Scale, a tool for assessing quality of observational studies. The random effects model evaluated pooled summary estimates of nonadherence. RESULTS From 510 abstracts, 31 studies comprising 16,398 patients with MS treated with daily oral DMDs were included. Overall 1-year mean medication possession ratio (MPR; n = 4 studies) was 83.3% (95% confidence interval [CI] 74.5-92.1%) and proportion of days covered (PDC; n = 4 studies) was 76.5% (95% CI 72.0-81.1%). Pooled 1-year MPR ≥80% adherence (n = 6) was 78.5% (95% CI 63.5-88.5%) and PDC ≥80% (n = 5 studies) was 71.8% (95% CI 59.1-81.9%). Pooled 1-year discontinuation (n = 20) was 25.4% (95% CI 21.6-29.7%). CONCLUSIONS Approximately one in five patients with MS do not adhere to, and one in four discontinue, daily oral DMDs before 1 year. Opportunities to improve adherence and ultimately patient outcomes, such as patient education, medication support/reminders, simplified dosing regimens, and reducing administration or monitoring requirements, remain. Implementation of efforts to improve adherence are essential to improving care of patients with MS.
Collapse
Affiliation(s)
| | | | | | | | - Megan Grosso
- EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Rockland, MA, USA
| | - Amy L Phillips
- EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Rockland, MA, USA
| |
Collapse
|
17
|
Garabedian M, Perrone E, Pileggi C, Zimmerman V. Support Group Participation: Effect on Perceptions of Patients with Newly Diagnosed Multiple Sclerosis. Int J MS Care 2020; 22:115-121. [PMID: 32607073 DOI: 10.7224/1537-2073.2018-099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Patients newly diagnosed as having multiple sclerosis (MS) face an overwhelming number of questions about how it will affect their lives. Participation in a support group is one way to obtain information and receive support from others. However, existing support groups are often attended by patients with significant disability, resulting in newly diagnosed patients being hesitant to return. Methods This qualitative pilot study explored perceptions of patients with newly diagnosed MS before and after participation in two monthly meetings. A support group was conducted each month using nursing staff, a physician, and a social worker. Prior to the first meeting, participants were asked to complete a questionnaire with open-ended questions to share their thoughts about how MS may affect their lives. After the two meetings, they were asked to complete the same questionnaire again. Results Eight themes were identified: uncertain disease course; insecure future; physical, emotional, and cognitive impacts; effect on relationships with family and/or spouse/significant other; ability to develop future relationship with significant other; impact on career plans; impact on ability to achieve future goals; and impact on ability to care for self and family. Five of six participants who attended both meetings and one of four who attended only the first meeting expressed a change in their perception of how MS may affect their lives. Conclusions A support group dedicated exclusively to newly diagnosed patients may provide an opportunity for patients to experience a change in perceptions of MS.
Collapse
|
18
|
Aungst A, Casady L, Dixon C, Maldonado J, Moreo N, Pearsall L, Robertson D. Assessing Barriers to Adherence with the Use of Dimethyl Fumarate in Multiple Sclerosis. Clin Drug Investig 2020; 40:73-81. [PMID: 31599395 DOI: 10.1007/s40261-019-00866-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory, central nervous system demyelinating disease that requires long-term use of disease-modifying therapies (DMT). Patient adherence to DMT is key in reducing the inflammation that leads to relapses and neurodegeneration. Dimethyl fumarate (DMF) poses unique challenges to adherence including being the only twice-daily dosing DMT. Previous research suggests there are direct roles that providers play on improving their patients' adherence rates, such as focusing on the patient-provider relationship, helping put the patient at ease so that they feel understood and respected. Also, route of administration affects adherence in other chronic healthcare conditions. However, the issue of adherence to DMT in MS is more complex than just route of administration, with adverse effects being the main predictor of adherence. OBJECTIVES (1) To define various patient specific factors (e.g. fatigue and mood disorders) that affect adherence with DMF and (2) to understand how patients' perceptions of treatment satisfaction (such as effectiveness, convenience, side effects and global satisfaction) and DMFs impact on quality of life (such as social support, activities of daily living, coping) influence adherence. METHODS Our study was a prospective, observational measurement of adherence to treatment with DMF in MS patients over 52 weeks. Twenty-five out of thirty-five patients enrolled completed the study. Adverse event (AE) data was reviewed on all participants. RESULTS Adherence rates correlated with patient's perceived effectiveness (0.25, p < 0.023) and the level of bothersome symptoms the patient experienced (0.45, p < 0.0001). The majority of new AE onset was reported within 12 weeks of DMF initiation. This is consistent with previously published data with DMF use. CONCLUSION Adherence rates are an important factor to be considered when starting patients on DMT. DMF creates its own barriers to adherence with our study highlighting some, including twice-daily dosing and AEs experienced following treatment initiation. Healthcare providers should be aware of these barriers prior to treatment initiation and counsel patients appropriately.
Collapse
Affiliation(s)
- Angela Aungst
- Department of Neurology Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr, Tampa, FL, 33612, USA.
| | - Lise Casady
- Department of Neurology Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr, Tampa, FL, 33612, USA
| | - Crystal Dixon
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Janice Maldonado
- Department of Neurology Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr, Tampa, FL, 33612, USA
| | - Natalie Moreo
- Department of Neurology Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr, Tampa, FL, 33612, USA
| | - Laurie Pearsall
- Department of Neurology Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr, Tampa, FL, 33612, USA
| | - Derrick Robertson
- Department of Neurology Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr, Tampa, FL, 33612, USA
| |
Collapse
|
19
|
Pust GEA, Untiedt B, Randerath J, Barabasch A, Köpke S, Rahn AC, Hansen H, Heesen C. Exploring Adherence to First-Line and Second-Line Immunotherapies in Multiple Sclerosis: An Interview Study. Int J MS Care 2020; 22:219-225. [PMID: 33177958 DOI: 10.7224/1537-2073.2018-068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Treatment adherence is fundamental in multiple sclerosis (MS) management. Adherence rates vary significantly between studies, ranging from 30% to almost 90%, depending on assessment method and medication type. This study aimed to identify patient-related categories associated with treatment modification or discontinuation in people with MS receiving either first- or second-line treatment. Methods Semistructured interviews were performed with 23 people with MS: 11 receiving first-line treatment and 12 receiving second-line treatment. Medication history, experiences with previous medications, decision-making processes regarding immunotherapy, adherence behavior, and reasons for adherence/nonadherence were explored using open-ended questions. Qualitative content analysis was performed using a combined deductive-inductive approach in building a coding frame. Differences in coding frequencies were compared between the two groups and analyzed quantitatively. Cohen's kappas of 0.76 for people with MS receiving first-line treatment and 0.64 for the second-line sample were achieved between the two coders. Results One key reason for nonadherence reported by first-line-treated people with MS was burdensome side effects, and for adherence was belief in medication effectiveness. In people with MS receiving second-line treatment, lack of perceived medication effectiveness was a key category related to changes in or discontinuation of immunotherapy. Reasons for adherence were positive illness beliefs/perceptions and belief in highly active disease. Intentional nonadherence was a major issue for first-line treatment and less relevant for second-line treatment. Conclusions These results indicate specific differences in factors mitigating adherence in people with MS receiving first- and second-line treatment.
Collapse
|
20
|
Zarei S, Maldonado I, Franqui-Dominguez L, Rubi C, Rosa YT, Diaz-Marty C, Coronado G, Nieves MCR, Akhlaghipour G, Chinea A. Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients. Surg Neurol Int 2019; 10:200. [PMID: 31768280 PMCID: PMC6826276 DOI: 10.25259/sni_252_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.
Collapse
Affiliation(s)
- Sara Zarei
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Irvin Maldonado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | - Yanibel Tapia Rosa
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Cristina Diaz-Marty
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Guadalupe Coronado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | | |
Collapse
|
21
|
Sadigh G, Saindane AM, Waldman AD, Lava NS, Hu R. Comparison of Unenhanced and Gadolinium-Enhanced Imaging in Multiple Sclerosis: Is Contrast Needed for Routine Follow-Up MRI? AJNR Am J Neuroradiol 2019; 40:1476-1480. [PMID: 31439627 DOI: 10.3174/ajnr.a6179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/06/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gadolinium enhanced MRI is routinely used for follow-up of patients with multiple sclerosis. Our aim was to evaluate whether enhancing multiple sclerosis lesions on follow-up MR imaging can be detected by visual assessment of unenhanced double inversion recovery and FLAIR sequences. MATERIALS AND METHODS A total of 252 consecutive MRIs in 172 adult patients with a known diagnosis of multiple sclerosis were reviewed. The co-presence or absence of associated double inversion recovery and FLAIR signal abnormality within contrast-enhancing lesions was recorded by 3 neuroradiologists. In a subset of patients with prior comparisons, the number of progressive lesions on each of the 3 sequences was assessed. RESULTS A total of 34 of 252 MRIs (13%) demonstrated 55 enhancing lesions, of which 52 (95%) had corresponding hyperintensity on double inversion recovery and FLAIR. All lesions were concordant between double inversion recovery and FLAIR, and the 3 enhancing lesions not visible on either sequence were small (<2 mm) and cortical/subcortical (n = 2) or periventricular (n = 1). A total of 17 (22%) of the 76 MRIs with a prior comparison had imaging evidence of disease progression: Ten (59%) of these showed new lesions on double inversion recovery or FLAIR only, 6 (35%) showed progression on all sequences, and 1 (6%) was detectable only on postcontrast T1, being located in a region of confluent double inversion recovery and FLAIR abnormality. CONCLUSIONS There was a high concordance between enhancing lesions and hyperintensity on either double inversion recovery or FLAIR. Serial follow-up using double inversion recovery or FLAIR alone may capture most imaging progression, but isolated enhancing lesions in confluent areas of white matter abnormality could present a pitfall for this approach.
Collapse
Affiliation(s)
- G Sadigh
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| | - A M Saindane
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| | - A D Waldman
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| | - N S Lava
- Neurology (N.S.L.), Emory University School of Medicine, Atlanta, Georgia
| | - R Hu
- From the Departments of Radiology and Imaging Sciences (G.S., A.M.S., A.D.W., R.H.)
| |
Collapse
|
22
|
Schlegel V, Leray E. From Medical Prescription to Patient Compliance: A Qualitative Insight into the Neurologist-Patient Relationship in Multiple Sclerosis. Int J MS Care 2018; 20:279-286. [PMID: 30568565 DOI: 10.7224/1537-2073.2017-043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Approximately 12 disease-modifying treatments are available worldwide for patients with relapsing multiple sclerosis (MS). These recent therapeutic advances have led to major changes in patient and neurologist attitudes toward drug prescription. Herein, we aimed to characterize patient choice regarding treatment for MS and identify how neurologists assess and monitor patient compliance during follow-up. Methods In 29 patients with MS, we observed visits to their neurologist to understand how questions related to compliance were addressed in the doctor-patient relationship. Face-to-face interviews were conducted with 15 of the 29 patients to discuss how they dealt with their drug prescription from a patient-centered perspective. Results Of the 15 patients with MS, nine were offered a choice of treatment. However, we found that neurologists were not always willing to consider the patients' input. Even if physicians attempt to align treatment choice with patient preferences to ensure compliance, preferences are often assumed rather than solicited from patients. Furthermore, patients may be unwilling to make their own treatment decisions. Various ways for neurologists to assess compliance during visits were also identified. Noncompliance can be considered as a way for patients to communicate their preferences and demonstrate involvement in their drug therapy, and it can lead to a renegotiation of the current treatment course. Conclusions These findings suggest that the neurologist-patient relationship has a great influence on patient compliance throughout the MS disease course.
Collapse
|
23
|
Simacek KF, Ko JJ, Moreton D, Varga S, Johnson K, Katic BJ. The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study. J Med Internet Res 2018; 20:e11168. [PMID: 30377144 PMCID: PMC6234348 DOI: 10.2196/11168] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In the United States, people with relapsing-remitting multiple sclerosis (RRMS) can face difficulty accessing disease-modifying therapies (DMTs) because of insurance, pharmacy, or provider policies. These barriers have been associated with poor adherence and negative health outcomes. OBJECTIVE The goals of this study were to describe the overall occurrence of difficulties and delays associated with gaining access to DMTs among people with RRMS, to assess DMT adherence during periods of reduced access, and to contextualize the patients' journey from receipt of a prescription for DMT to obtaining and taking their medication when faced with access barriers. METHODS We recruited US-based adults self-reporting RRMS from a Web-based health data-sharing social network, PatientsLikeMe. Individuals were invited to complete a Web-based survey if they reported a diagnosis of RRMS and were prescribed a DMT for MS. Follow-up phone interviews were conducted with 10 respondents who reported experiencing an MS-related relapse during the time they had experienced challenges accessing DMTs. RESULTS Among 507 survey completers, nearly half were either currently experiencing an issue related to DMT assess or had difficulty accessing a DMT in the past (233/507, 46.0%). The most frequently reported reasons for access difficulty were authorization requirements by insurance companies (past issues: 78/182, 42.9%; current issues: 9/42, 21%) and high out-of-pocket costs (past issues: 54/182, 29.7%; current issues: 13/42, 31%). About half (20/39, 51%) of participants with current access issues and over a third (68/165, 41.2%) of those with past issues went without their medication until they could access their prescribed DMT. Relapses were reported during periods of reduced DMT access for almost half (56/118, 47.5%) of those with past issues and nearly half (22/45, 49%) of those with current issues. Resolving access issues involved multiple stakeholder agents often coordinated in a patient-led effort. Among those who had resolved issues, about half (57/119, 47.9%) reported that doctors or office staff were involved, under half (48/119, 40.3%) were involved themselves, and about a third (39/119, 32.8%) reported the drug manufacturer was involved in resolving the issue. Follow-up interviews revealed that the financial burden associated with obtaining a prescribed DMT led to nonadherence. Additionally, participants felt that DMT treatment delays and stress associated with obtaining the DMT triggered relapses or worsened their MS. CONCLUSIONS This study expands current research by using a patient-centered, mixed-methods approach to describe barriers to MS treatment, the process to resolve barriers, and the perceived impact of treatment barriers on outcomes. Issues related to DMT access occur frequently, with individuals often serving as their own agents when navigating access difficulties to obtain their medication(s). Support for resolution of DMT access is needed to prevent undue stress and nonadherence.
Collapse
Affiliation(s)
| | - John J Ko
- Health Economic and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | | | - Stefan Varga
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kristen Johnson
- Health Economic and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Bozena J Katic
- Research and Development, PatientsLikeMe, Cambridge, MA, United States
| |
Collapse
|
24
|
Nicholas J, Boster A, Wu N, Yeh WS, Fay M, Kendter J, Huang MY, Lee A. Comparison of Disease-Modifying Therapies for the Management of Multiple Sclerosis: Analysis of Healthcare Resource Utilization and Relapse Rates from US Insurance Claims Data. PHARMACOECONOMICS - OPEN 2018; 2:31-41. [PMID: 29464673 PMCID: PMC5820236 DOI: 10.1007/s41669-017-0035-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Data on comparative healthcare resource utilization and costs associated with the newer oral disease-modifying therapies (DMTs) for managing relapsing-remitting multiple sclerosis (MS) in routine clinical practice are limited. The purpose of this study was to estimate healthcare resource utilization, costs, and relapse rates in the year after initiating treatment with dimethyl fumarate (DMF), interferon (IFN)-β, glatiramer acetate (GA), teriflunomide, or fingolimod in routine clinical practice for patients with MS who did not receive a DMT in the previous year. METHODS Patients initiating DMF, IFNβ, GA, teriflunomide, or fingolimod were identified based on claims data from 2012 to 2015 in the Truven MarketScan Commercial Claims Databases (n = 4194). Healthcare resource utilization assessment included the proportion of patients who were hospitalized, or had emergency room (ER) or urgent care (UC) visits. Healthcare costs were estimated for 1 year before and 1 year after DMT initiation. Relapse episodes were identified based on a published claims-based algorithm and clinical input from the research investigators. RESULTS After DMT initiation, significant reductions in the proportions of patients who were hospitalized or requiring ER/UC visits were observed in all patient cohorts (p < 0.001 and p < 0.05, respectively). Non-prescription medical costs decreased after DMT initiation, with the largest decrease observed in the DMF cohort (US$5761 reduction, p < 0.0001). Reductions in non-prescription medical costs were associated with decreased use of outpatient services and inpatient hospital stays, and have the potential to partially offset DMT costs. CONCLUSIONS DMT initiation is associated with reductions in healthcare resource utilization and non-prescription medical costs in routine clinical practice.
Collapse
Affiliation(s)
- Jacqueline Nicholas
- OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, OH, USA
| | - Aaron Boster
- OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, OH, USA
| | - Ning Wu
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Wei-Shi Yeh
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Monica Fay
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Jon Kendter
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Ming-Yi Huang
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | - Andrew Lee
- Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
| |
Collapse
|
25
|
Torre-Alonso JC, Queiro R, Comellas M, Lizán L, Blanch C. Patient-reported outcomes in European spondyloarthritis patients: a systematic review of the literature. Patient Prefer Adherence 2018; 12:733-747. [PMID: 29780239 PMCID: PMC5951138 DOI: 10.2147/ppa.s162420] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE This review aims to summarize the current literature on patient-reported outcomes (PROs) in spondyloarthritis (SpA). PATIENTS AND METHODS We performed a systematic literature review to identify studies (original articles and narrative and systematic reviews) regarding PROs (health-related quality of life [HRQoL], satisfaction, preferences, adherence/compliance, and persistence) in SpA patients published in the European Union through December 2016. International databases (Medline/PubMed, Cochrane Library, ISI Web of Knowledge, Scopus) were searched using keywords in English. The methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine criteria. RESULTS A total of 26 publications met the inclusion criteria. Generally, studies indicated that SpA has a negative impact on patients' HRQoL. In patients with ankylosing spondylitis, physical domains were more affected than emotional ones, whereas for psoriatic arthritis, both physical and psychological factors were strongly affected by the disease. Data indicated that biological agents (BAs) greatly contributed to improvement in HRQoL in both ankylosing spondylitis and psoriatic arthritis patients. Findings on compliance with BAs were heterogeneous. However, persistence rates exceeded 50% irrespective of the BA administered. Results on preferences indicated that most SpA patients prefer being involved in decisions regarding their treatment and that besides efficacy and safety, frequency and route of administration may influence patients' preferences for BAs. CONCLUSION Implementing management programs for SpA patients focuses on the physical, emotional, and social consequences of the disease, in addition to assessing and including patient preferences in the treatment decision-making process, could be crucial to improve patients' HRQoL and ensure their satisfaction and compliance with treatment.
Collapse
Affiliation(s)
- Juan Carlos Torre-Alonso
- Rheumatology Department, Faculty of Medicine and Health Sciences, University of Oviedo, Hospital Monte Naranco, Oviedo, Spain
- Correspondence: Juan Carlos Torre-Alonso, Facultad de Medicina y Ciencias de la Salud, Reumatología Hospital Universitario Monte Naranco, 107 Avenida Doctores Fernández Vega, Oviedo, Asturias 33012, Spain, Tel +34 985 106 900, Email
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - Luís Lizán
- Outcomes 10, Castellón de la Plana, Spain
- Medicine Department, Jaime I University, Castellón de la Plana, Spain
| | - Carles Blanch
- Health Economics & Market Access, Novartis Pharmaceuticals, Barcelona, Spain
| |
Collapse
|
26
|
Hao J, Pitcavage J, Jones J, Hoegerl C, Graham J. Measuring Adherence and Outcomes in the Treatment of Patients With Multiple Sclerosis. J Osteopath Med 2017; 117:737-747. [DOI: 10.7556/jaoa.2017.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Context
Both adherence and outcomes are more difficult to measure in patients with multiple sclerosis (MS) than in patients with diseases such as hypertension, for which most medications are taken orally and surrogate outcomes (eg, blood pressure) are routinely collected.
Objectives
To characterize the adherence and outcomes of patients with MS within a large integrated health system and to assess the relationship between adherence and outcomes.
Study Design
Retrospective review of adherence and health care utilization outcomes via electronic health records and claims (2004-2013) combined with a prospective survey regarding adherence and functional outcomes (2012-2013).
Methods
Retrospectively, medication possession ratios were calculated, and adherence groups were compared regarding health care utilization and costs. Prospectively, patients were recruited to complete questionnaires to measure self-reported adherence (SRA) and MS-specific outcomes, including the Multiple Sclerosis Impact Scale (MSIS), the Kurtzke Expanded Disability Status Scale (EDSS), and the Treatment Satisfaction Questionnaire for Medication (TSQM). Regression was used to statistically test for differences in these outcomes among adherence groups.
Results
A total of 681 patients were studied. Most patients (307 of 375 [82%] in the retrospective cohort and 244 of 306 [89%] in the prospective cohort) had greater that 80% adherence to their MS medications. Mean inpatient days per patient for MS-related admissions was highest for high-adherence than for intermediate and low-adherence patients (0.52 vs 0.23 and 0.34, respectively; P<.001), but no other associations between adherence and health care utilization were found. Mean outpatient costs and total costs were lowest for the low-adherence group, suggesting that higher adherence may not guarantee cost savings overall. Patients with intermediate and high self-reported adherence showed significantly better mean scores than patients with low adherence on several MS outcomes, including EDSS (4.1 and 4.2 vs 4.8, P<.05), MSIS physical function (33 and 35 vs 41, P<.05), and TSQM Global Satisfaction (75 and 78 vs 70, P<.05).
Conclusions
The findings of this study indicate that patients with MS are mostly adherent to their existing treatments. Patients with greater medication adherence may have increased cost, but their physical outcomes are better. This finding may shed light on other chronic disease entities and how we view the success of treatments.
Collapse
|
27
|
Burks J, Marshall TS, Ye X. Adherence to disease-modifying therapies and its impact on relapse, health resource utilization, and costs among patients with multiple sclerosis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:251-260. [PMID: 28496344 PMCID: PMC5417677 DOI: 10.2147/ceor.s130334] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) initiating oral and injectable DMTs, and to estimate the impact of adherence on relapse, health resource utilization, and medical costs. Patients and methods Commercially insured MS patients (aged 18–65 years, two or more MS diagnoses, one or more DMT claims) with continuous eligibility 12 months before and after the first DMT claim date (index date) and no DMT claim during the pre-index period were identified from a large commerical claims database for the period from January 1, 2008, to September 30, 2015. Adherence to the index DMT was measured by the 12-month post-index proportion of days covered (PDC) and compared between oral and injectable DMT initiators. After adjustment for sex, age at index DMT, and comorbidities, regression models examined the relationship between adherence and relapse risk, MS-related health resource utilization, and non-drug medical costs (2015 US$). Results The study covered 12,431 patients and nine DMTs. Adherence to the index DMT did not differ significantly between oral (n=1,018) and injectable (n=11,413) DMTs when assessed by mean PDC (0.7257±0.2934 vs 0.7259±0.2869, respectively; P=0.0787), or percentages achieving PDC ≥0.8 (61.4% vs 58.6%, respectively; P=0.0806). Compared to non-adherence, adherence to DMT significantly reduced the likelihood of relapse in the post-index 12 months by 42%, hospitalization by 52%, and emergency visits by 38% (all, P<0.0001). Adherent patients would be expected to have on average 0.7 fewer outpatient visits annually versus non-adherent patients (P<0.0001). Based on the differences in predicted mean costs, adherence (vs non-adherence) would decrease the total annual medical care costs by $5,816 per patient, including hospitalization costs by $1,953, emergency visits by $171, and outpatient visits by $2,802. Conclusion Adherence remains suboptimal but comparable between oral and injectable DMTs. Potential health and economic benefits underscore the importance of improving adherence in MS.
Collapse
|
28
|
Tintoré M, Alexander M, Costello K, Duddy M, Jones DE, Law N, O’Neill G, Uccelli A, Weissert R, Wray S. The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction. Patient Prefer Adherence 2017; 11:33-45. [PMID: 28053511 PMCID: PMC5189708 DOI: 10.2147/ppa.s115090] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. METHODS A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. RESULTS A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. CONCLUSION Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.
Collapse
Affiliation(s)
- Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron, Barcelona, Spain
- Correspondence: Mar Tintoré, Multiple Sclerosis Centre of Catalonia, Hospital Vall d’Hebron EUI 2ª Pl, Ps. Vall d’Hebron, 119-129, 08035 Barcelona, Spain, Tel +34 93 274 6202, Fax +34 93 274 6084, Email
| | | | | | - Martin Duddy
- Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - David E Jones
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Nancy Law
- Nancy Law Consulting LLC, Parker, CO, USA
| | | | - Antonio Uccelli
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Robert Weissert
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sibyl Wray
- Hope Neurology Multiple Sclerosis Center, Knoxville, TN, USA
| |
Collapse
|
29
|
Edo Solsona MD, Monte Boquet E, Casanova Estruch B, Poveda Andrés JL. Impact of adherence on subcutaneous interferon beta-1a effectiveness administered by Rebismart ® in patients with multiple sclerosis. Patient Prefer Adherence 2017; 11:415-421. [PMID: 28280313 PMCID: PMC5338953 DOI: 10.2147/ppa.s127508] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Adherence to disease-modifying drugs (DMDs) is one of the key factors for achieving optimal clinical outcomes. Rebismart® is an injection device for subcutaneous administration of interferon beta-1a (INF β-1a) that is also able to monitor adherence objectively. The aim of this study was to describe adherence to INF β-1a using the said electronic autoinjection device and to explore the relationship between adherence and relapses in a Spanish cohort. METHODS This is a retrospective observational study in which 110 Spanish patients self-administered INF β-1a subcutaneously using an electronic autoinjection device between June 2010 and June 2015. The primary end point was the percentage of adherence measured by Rebismart® to subcutaneous INF β-1a injections calculated as number of injections received in time period versus number of injections scheduled in time period. Other variables recorded were demographic and clinical data. Statistical analysis was performed using SPSS 19.0 software. RESULTS Median adherence for the total study period was 96.5% (interquartile range [IQR]: 91.1-99.1). Similar values were observed during the first 6 months: 98.7% (IQR: 91.3-100), and the last 6 months: 97.6% (IQR: 91.1-99.8). Median duration of treatment was 979 days (IQR: 613.8-1,266.8). During the entire treatment period, 77.3% of patients were relapse free and mean annualized relapse rate was 0.14 (standard deviation: 0.33). Increased adherence was associated with better clinical outcomes, leading to lower relapse risk (odds ratio: 0.953; 95% confidence interval: 0.912-0.995). Specifically, every percentage unit increase in adherence resulted in a 4.7% decrease in relapse. CONCLUSION Patients with multiple sclerosis who self-injected INF β-1a with Rebismart® had excellent adherence, correlating with a high proportion of relapse-free patients and very low annualized relapse rate.
Collapse
|
30
|
Garcia-Dominguez JM, Muñoz D, Comellas M, Gonzalbo I, Lizán L, Polanco Sánchez C. Patient preferences for treatment of multiple sclerosis with disease-modifying therapies: a discrete choice experiment. Patient Prefer Adherence 2016; 10:1945-1956. [PMID: 27713622 PMCID: PMC5045232 DOI: 10.2147/ppa.s114619] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess disease-modifying therapy (DMT) preferences in a population of patients with multiple sclerosis (MS) and to estimate the association between sociodemographic and clinical factors and these preferences. METHODS Preferences for DMTs attributes were measured using a discrete choice experiment. Analysis of preferences was assessed using mixed-logit hierarchical Bayes regression. A multilinear regression was used to evaluate the association between the preferences for each attribute and patients' demographic and clinical characteristics. A Student's t-test or Welch's t-test was used for subgroup comparisons. RESULTS A total of 125 patients were included in the final analysis (62.9% female, mean age 44.5 years, 71.5% with relapsing-remitting MS diagnosis). The most important factor for patients was the possibility of suffering from the side effects of the treatment (relative importance [RI] =50%), followed by a delay in disease progression (RI =19.4%), and route and frequency of administration (RI =14.3%). According to maximum acceptable risk, patients were willing to accept an increase of 3.8% in severity of side effects, for a delay of 1 year in disease progression. Treatment duration was the most prevalent factor affecting preferences, followed by the age of patients, type of MS, level of education, and the type of current treatment. Patients treated orally were significantly more concerned about the route and frequency of administration (P=0.026) than patients on injectable therapy. Naïve patients stated significantly less importance to prevention of relapses (P=0.021) and deterioration of the capacity for performing usual daily life activities (P=0.015). Finally, patients with >5 years since diagnosis were significantly less concerned about preventing disease progression (P=0.021), and more concerned about treatment side effects (P=0.052) than compared with patients with <5 years of MS history. CONCLUSION The most important attribute for MS patients was side effects of DMTs, followed by delay in disability progression. Experience with DMTs and time since MS diagnosis changed patients' preferences. These results give information to adjust new DMT treatment in order to satisfy patients' preferences and therefore, improve adherence to treatment.
Collapse
Affiliation(s)
| | - Delicias Muñoz
- Neurology Department, Hospital Universitario Alvaro Cunqueiro, Vigo
| | | | | | - Luis Lizán
- Outcomes’10, Jaime I University, Castellón
| | | |
Collapse
|
31
|
Nolla JM, Rodríguez M, Martin-Mola E, Raya E, Ibero I, Nocea G, Aragon B, Lizán L, Prades M. Patients' and rheumatologists' preferences for the attributes of biological agents used in the treatment of rheumatic diseases in Spain. Patient Prefer Adherence 2016; 10:1101-13. [PMID: 27382258 PMCID: PMC4920238 DOI: 10.2147/ppa.s106311] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To define importance values assigned to attributes of biological agents (BAs) by Spanish patients with rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and rheumatologists. PATIENTS AND METHODS This was an observational, cross-sectional design based upon a rank-based full-profile conjoint analysis. A literature review and four focus groups were undertaken to identify attributes and levels. An orthogonal matrix, combining the selected levels of attributes, was used to define scenarios. Participants ranked eight scenarios from 1 (most preferred) to 8 (least preferred). The relative importance (RI) of attributes was calculated. Multivariate regression analysis was performed to identify the characteristics that influenced the values of RI. A total of 488 patients (male 50.9%, mean age 50.6 [standard deviation {SD} 12.06] years, rheumatoid arthritis 33.8%, ankylosing spondylitis 32.4%, psoriatic arthritis 33.8%; mean time since diagnosis 12.6 [SD 8.2] years) and 136 rheumatologists (male 50.4%, mean age 46.4 [SD 9.1] years, mean time of practice 16.7 [SD 8.8] years) participated. RESULTS The ideal BAs for patients and physicians, respectively, should allow pain relief and improvement of functional capacity (RI 39% and 44.7%), with low risk of adverse events (RI 24.9% and 30.5%), a long time prior to perceiving the need for a new dose (RI 16.4% and 12.4%), and self-administration at home (RI 19.7% and 12.5%), as identified through their preferences. CONCLUSION Although efficacy and safety are paramount for patients and rheumatologists to make a choice regarding BAs, the need for a low frequency of administration and the administration method also play a role as preference attributes for BAs.
Collapse
Affiliation(s)
- Joan M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Correspondence: Joan Miquel Nolla, Department of Rheumatology, Hospital Universitari de Bellvitge, Feixa Llarga, L’Hospitalet de Llobregat, Barcelona 08907, Spain, Tel +34 932 607 615, Email
| | - Manuel Rodríguez
- Department of Rheumatology, Complejo Hospitalario de Ourense, Ourense, Spain
| | - Emilio Martin-Mola
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Enrique Raya
- Department of Rheumatology, Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | |
Collapse
|
32
|
Morillas C, Feliciano R, Catalina PF, Ponte C, Botella M, Rodrigues J, Esmatjes E, Lafita J, Lizán L, Llorente I, Morales C, Navarro-Pérez J, Orozco-Beltran D, Paz S, Ramirez de Arellano A, Cardoso C, Tribaldos Causadias M. Patients' and physicians' preferences for type 2 diabetes mellitus treatments in Spain and Portugal: a discrete choice experiment. Patient Prefer Adherence 2015; 9:1443-58. [PMID: 26508841 PMCID: PMC4612138 DOI: 10.2147/ppa.s88022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To assess Spanish and Portuguese patients' and physicians' preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects. METHODS An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model. RESULTS Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m(2), 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55-85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29-82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31-1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63-843.09] and €154.30 [98.13-434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30-622.75) and €24.28 (18.41-30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39-543.62) and €42.74 (23.89-61.77) to avoid nausea. CONCLUSION Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively.
Collapse
Affiliation(s)
| | | | | | | | - Marta Botella
- Hospital Universitario Principe de Asturias, Madrid, Spain
| | | | | | | | - Luis Lizán
- Outcomes'10, Universidad Jaume I, Castellón, Spain
| | - Ignacio Llorente
- Hospital Universitario Nuestra Señora de la Candelaria, Canarias, Spain
| | | | | | | | - Silvia Paz
- Outcomes'10, Universidad Jaume I, Castellón, Spain
| | | | | | | |
Collapse
|