To understand adherence, persistence and switching patterns among patients with multiple sclerosis (MS) initiating disease-modifying therapy (DMT).

Real-world evidence characterizing treatment pathways with ocrelizumab is limited. 

This analysis used the PharMetrics Plus commercial claims database. Patients with MS initiating a new DMT in April 2017–March 2018 were observed for ≥1 year pre- and post-DMT initiation. For the initiated DMT, ≥2 prescriptions were required; completing Dose 1 met this requirement for ocrelizumab. Comparator DMTs were grouped by administration route: injectable, oral and intravenous. The proportion of days covered (PDC) was calculated as (total days of DMT supply during post-initiation year)/(365 days). One-year persistence was defined as no switch to other DMTs and no gap in supply >60 days between last fill date and the end of the post-initiation year for non-ocrelizumab DMTs; for ocrelizumab, it was defined as second dose within the post-initiation year. Treatment patterns were described for patients switching DMTs within 1 year. Multivariable Poisson regression models compared nonadherence (PDC <0.80) and discontinuation (nonpersistence) across DMTs.

A total of 2,561 patients (ocrelizumab, n=729; injectable, n=510; oral, n=1,109; intravenous, n=213) were included. Patients initiating ocrelizumab had the highest mean PDC (adherence; 91.4%) vs other groups (injectable, 73%; oral, 77%; intravenous, 81%) and the lowest proportion of patients discontinuing (9% vs 38%, 29% and 25%, respectively). A small number of patients switching from ocrelizumab within 1 year (n=7) were most likely to switch to another intravenous DMT (57%) or oral DMT (28.5%). Compared with ocrelizumab, patients initiating injectable, oral and intravenous DMTs were 2–3 times more likely to be nonadherent and 3–5 times more likely to discontinue treatment (p<0.001 for all comparisons with ocrelizumab). 

In a real-world setting, patients initiating ocrelizumab were the least likely to discontinue or switch therapy within 1 year.