Study: Adherence Better With Oral Multiple Sclerosis Therapy Than Self-Administered Injections

A Novartis-sponsored study found better continuation rates and higher adherence in participants receiving oral disease-modifying therapy for multiple sclerosis.

Fingolimod, the only oral disease-modifying therapy (DMT) for multiple sclerosis (MS) available in the United States, is associated with higher adherence and lower discontinuation rates than self-injected DMTs, the results of a recent study suggest.

The study, published in the October 4, 2013, edition of BMC Neurology, was sponsored by Novartis Pharmaceuticals Corporation, which markets fingolimod as Gilenya in the United States. Several of the authors were contracted by the corporation to collaborate on the study, and several were Novartis employees. None reported competing interests.

Using pharmacy claims data dated between October 2009 and February 2012 from pharmacy benefits manager Medco Health Solutions, researchers identified 1891 participants initiating DMT therapy. The researchers then compared compliance and discontinuation rates between participants receiving oral therapy and participants receiving self-injected therapy. They then used pharmacy claims data to determine (1) the proportion of days covered for participants receiving each therapy and (2) the medication possession ratio.

Fingolimod users tended to have a higher proportion of days covered and a higher medication possession ratio than participants receiving other therapies, as well as a higher proportion of patients in the most compliant category range. In addition, 68.8% of participants receiving fingolimod were therapy persistent at the 12-month follow-up. Persistence ranged from 46.1% to 56.3% among participants receiving other DMTs.

Despite being more compliant than participants receiving other DMT treatment, 27.8% of participants receiving fingolimod did discontinue therapy within 1 year of treatment initiation.

“While oral medications may offer an improvement in patient compliance to DMT treatment, other strategies or programs may need to be tested and implemented to further improve the treatment adherence for patients with chronic illness,” the authors wrote.

Across all of the therapies, most participants were treatment naïve, although the division of therapy among the claims data was fairly even: 13.1% received fingolimod, 10.7% received interferon beta-1b, 20% received intramuscular interferon beta-1a, 18.8% received subcutaneous interferon beta-1a, and 37.4% received glatiramer acetate. Although the percentage of DMT-naïve fingolimod users was significantly lower than those receiving the other therapies, the researchers noted that nontreatment-naïve participants were included in the fingolimod cohort in order to have a sufficient sample size.

The researchers also gathered prescription data, including the need for physician prior authorization, whether the therapy was on the insurance plan’s formulary, and whether the index prescription was filled via mail order pharmacy.

Approximately half of the pharmacy claims required insurance plan prior authorization, regardless of therapy type. The self-injectable therapies were on most plans’ formularies, and approximately half of the prescriptions were filled using mail order pharmacies. Fingolimod was only on 15.3% of formularies, however, and 74.6% of prescriptions were filled using mail order pharmacies. Participants’ copay amounts for a 30-day therapy supply were comparable among all of the DMTs, with the researchers detecting no significant difference in copays between each of the therapies.