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Abstract Details

Impact of Real-World Adherence on Effectiveness of First-Line DMTs in Multiple Sclerosis
MS and Related Diseases
P01 - (-)
215
BACKGROUND: Adherence to self-injectable DMTs for MS is suboptimal, which can negatively impact clinical outcomes. Assessing real-world effectiveness of DMTs must take real-world adherence into consideration.
DESIGN/METHODS: This Microsoft® Excel-based model estimated the impact of adherence on real-world effectiveness of fingolimod, subcutaneous (SC) and intramuscular (IM) interferon-beta (IFN ?) 1a, SC IFN ?1b, and glatiramer acetate. Adherence was defined as medication possession ratio (MPR) of 80% and above. The proportions of patients adherent to therapy were estimated from a retrospective observational claims study. Annualized relapse rates (ARR) for comparators were identified from Phase 3 placebo-controlled trials. The model assumes that adherent patients would have an ARR similar to those in clinical trials. The impact of non-adherence (MPR< 80%) on real-world ARR was calculated based on published claims studies. Placebo rates were pooled from clinical trials of new oral therapies, to estimate the untreated rates in recent years, which were used, along with the DMT ARR, to calculate the adjusted relapse rate reduction (ARRR) vs. placebo. Two-way sensitivity analyses were performed to assess the impact of the variable adherence rates and impact of adherence rate on effectiveness in the model.
RESULTS: The model showed that fingolimod is estimated to be the most effective DMT in real-world (ARRR: 54%), followed by SC IFN?-1b (ARRR: 29%), SC IFN ?-1a (ARRR: 28%), glatiramer acetate (ARRR: 26%), and IM IFN ?-1a (ARRR: 13%). Two-way sensitivity analyses showed that fingolimod had a higher ARRR in all scenarios.
CONCLUSIONS: Adherence has a significant impact on real-world effectiveness of MS treatments. Fingolimod's high trial-based efficacy and its high observed adherence relative to self-injected DMTs contribute to its high estimated real-world RRR compared to other first-line treatments.
Authors/Disclosures
David W. Brandes, MD, FÂ鶹´«Ã½Ó³»­
PRESENTER 		No disclosure on file
No disclosure on file
No disclosure on file
Neetu Agashivala (Novartis Pharmaceutical Corporation) No disclosure on file
Edward Kim (Novartis Pharmaceuticals Corporation) No disclosure on file
No disclosure on file