In this study, we looked at treatment persistency in patients with multiple sclerosis taking injectable disease-modifying therapies. So, mainly what we wanted to see is if patients initiated treatment with an injectable DMT, how persistent were they in continuing that in terms of, did they continue it long-term throughout this study or did they stop it early? And if they stopped it and were not persistent with their treatments, what were those reasons that tended to affect that?
We saw that there are relatively high levels of persistence when you look early on, at about 3 months. But if you follow out the study for about 24 months, only 61% of patients who initiated DMT with an injectable therapy actually were still on that same injectable DMT.
I think the factors that we saw that affected that were not surprising. The reasons why patients discontinued were mainly issues in regards to tolerability, needle phobia, fear of injecting, and also a perceived lack of efficacy.
I think it’s important to look at this issue because traditionally injectable disease-modifying therapies have been what neurologists, as a whole, will initiate in patients with relapsing MS from the start. One of the concerns that has arisen in the field of multiple sclerosis is that what we do for our patients early in the first 5 years of the disease is actually what matters in terms of how they do long-term.
If we’re putting patients on a disease-modifying therapy that they are not continuing, we know that it takes a while for some of these therapies to actually build up effectiveness, and so the concern is that if patients aren’t persistent, maybe we should be using a different means of therapy to initiate. So, perhaps if we were to find in subsequent studies that persistency was much greater on oral DMTs or infusible DMTs, that may lead to change in the field. Because we know that when patients are off therapy or they are frequently switching, they are more open to new disease activity from relapses and new lesions on MRI in future disability.
This was a retrospective study with multiple centers with neurologists who had many patients with multiple sclerosis. Basically what they did was they had a standardized guide as to how to abstract the data from their own charts. So, using that data, it was collected prospectively and then put into a database for our analysis.
On the patient selection, basically these had to be patients who initiated an injectable DMT within the time period of 2008 to 2013, because that’s the period that we studied. So, we had to have data from that indexed date following for 24 months forward. Basically, anybody with relapsing or remitting MS who fit into that category was selected from these groups. It was more of a descriptive analysis where the results were all tabulated in table format and then looked at in terms of percentages. We did use some SaaS software for some of these calculations, and then there was a post-hoc analysis to compare some of the results as well.
What we found was that — interestingly — injectable treatment persistence on disease-modifying therapy decreased over time. We saw that if patients were going to switch injectable DMTs, that occurred early — typically within the first three months. But if patients were switching for other reasons, we found that about only 61% of patients were being persistent on their injectable DMT over the 24-month period, and the most common reasons for lack of treatment persistence were the patient’s own tolerability, which I think is very understandable. Also, needle phobia and fear of injections, and then also perceived lack of efficacy.
I don’t think that there has been as much study on that. There have been some results that have come out that have shown a variety of findings. I think one of the issues is that our oral therapies are all very different in terms of the groups of patients that we use them in, and also in terms of their tolerability. But I think more studies need to be done to see if the persistence is better on our newer therapies — orals, as well as the infusible options.
So, I think it’s really important to start from day 1, when these patients are diagnosed and coming into the clinic, that we want to find the treatment that they’re going to feel good about taking that we also feel is also going to be efficacious enough to fight their disease. I always say that the treatment that you don’t take is the treatment that we know won’t work for you. And so if there is something that doesn’t fit into their lifestyle early on, that’s not going to be an excellent option for them.