Abstract
Background: Treatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real-world rates of persistence on disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and
reasons for DMT discontinuation.
Methods: Treatment data on 4,366 consecutive people with relapse-onset MS were pooled from 13 UK specialist centres during 2021. Inclusion criteria: exposure to at least one MS DMT, and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected
included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan-Meier
survival analyses were used to express DMT persistence.
Results: In 6,997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% CI 4.1 – 4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of
people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate.
Conclusions: Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalising treatment in MS.
reasons for DMT discontinuation.
Methods: Treatment data on 4,366 consecutive people with relapse-onset MS were pooled from 13 UK specialist centres during 2021. Inclusion criteria: exposure to at least one MS DMT, and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected
included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan-Meier
survival analyses were used to express DMT persistence.
Results: In 6,997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% CI 4.1 – 4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of
people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate.
Conclusions: Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalising treatment in MS.
| Original language | English |
|---|---|
| Article number | e16289 |
| Journal | European Journal of Neurology |
| Volume | 31 |
| Issue number | 7 |
| Early online date | 3 Apr 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 3 Apr 2024 |
Bibliographical note
Publisher Copyright:© 2024 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.