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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Neurology 1/2017

Reasons for discontinuation of subcutaneous interferon β-1a three times a week among patients with multiple sclerosis: a real-world cohort study

Zeitschrift:
BMC Neurology > Ausgabe 1/2017
Autoren:
Meritxell Sabidó-Espin, Rick Munschauer
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12883-017-0831-4) contains supplementary material, which is available to authorized users.

Abstract

Background

Continuation of interferon (IFN) β-based therapies is important for maximum treatment effectiveness in patients with multiple sclerosis (MS); however, few real-world data are available on discontinuation from IFN β. The aim of this cohort analysis was to estimate real-world discontinuation rates up to 3 years among MS patients in the United States taking subcutaneous (sc) IFN β-1a three times a week (tiw) and to identify whether the factors associated with discontinuation change over time.

Methods

Patient data were pooled from the MarketScan© Commercial and Medicare Supplemental healthcare claims databases. Patients with ≥1 multiple sclerosis diagnosis who were sc IFN β-1a tiw naïve, had ≥1 year of continuous eligibility before treatment, and ≥1 prescription were followed from first prescription (index date) until date of discontinuation, switch, or end of observation. Treatment status was analysed at exactly 1, 2 or 3 years after index. Multivariable models were used to identify drivers of discontinuation.

Results

Data from 5956 patients were included; 2862 patients (48.1%) discontinued therapy. Discontinuation rates were 36.9% (1 year), 49.5% (2 years) and 55.8% (3 years). A greater proportion of discontinuing patients had poor adherence (<80% [94.0%] versus ≥80% [51.7%]) or were taking additional medication at follow-up versus the overall population. Factors independently associated with discontinuation irrespective of time on therapy were increasing number of magnetic resonance imaging scans (1 year adjusted odds ratio 1.45, 95% confidence interval 1.26–1.67; 2 years 1.18, 1.06–1.32; 3 years 1.20, 1.07–1.34) and adherence <80% versus ≥80% (1 year 180.95, 135.84–241.03; 2 years 135.80, 100.10–184.23; 3 years 174.89, 115.27–265.38). Factors associated only with early discontinuation (at 1 year) were ≥3 sets of laboratory investigations versus none (2.54, 1.20–5.38), and anxiolytic use at follow-up (1.40, 1.06–1.82). Factors associated only with later discontinuation (at 2 years and/or at 3 years) were antidepressant use at follow-up (2 years 1.46, 1.10–1.94) and greater number of relapses (2 years 1.60, 1.11–2.30; 3 years 2.31, 1.27–4.22).

Conclusions

Potential drivers of discontinuation change over time. Improved awareness of the drivers of discontinuation could lead to targeted interventions to improve adherence.
Zusatzmaterial
Additional file 1: Table S1. Health care resource usage of patients with multiple sclerosis initiating subcutaneous interferon β-1a, three times weekly by discontinuation status. Table S2. Crude odds ratios of factors associated with discontinuation of subcutaneous interferon β-1a, three times weekly, at 1, 2, and 3 years, respectively. Table S3. Adjusted odds ratios of factors associated with discontinuation of subcutaneous interferon β-1a, three times weekly, at 1, 2, and 3 years, respectively, with adherence removed from the model. (DOCX 36 kb)
12883_2017_831_MOESM1_ESM.docx
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