Fecha de recepción: 30/06/2017 – Fecha de aceptación: 28/01/2018
Alañón Pardo MM, Áreas del Águila VL, Rodríguez Martínez M
Servicio de Farmacia. Hospital General Universitario de Ciudad Real. Ciudad Real (España)
María del Mar Alañón Pardo
Calle Real, 133
13380 Aldea del Rey (Ciudad Real)
Correo electrónico: firstname.lastname@example.org
Objectives: To analyze persistence with disease-modifying therapy (DMT) of patients with multiple sclerosis (MS).
Methods: A retrospective, observational study was conducted in patients with MS who initiated (naïve) or changed (pretreated) DMT with interferon beta (INF-β), glatiramer acetate (GA), fingolimod, and/or natalizumab between January 2009 and December 2014 at an outpatient pharmaceutical care unit in a general university hospital and were under follow-up until December 2015. Persistence with DMT was calculated after one (P1), two (P2), and five (P5) years, and was defined as the time elapsed since DMT onset until discontinuation (suspension or change).
Results: There were 115 DMT prescriptions (59 initial, 56 changed). P1, P2, and P5 were 78.3%, 62.1%, and 30.8%, respectively. Persistence was higher (p≤0.030) with intramuscular-INF-β-1-A than with GA at one (92.5% vs. 40.0%) and two years (68.8% vs. 21.4%). The median interval to DMT discontinuation was 46.5 months [95% CI: 39.9-52.9], being shorter in pretreated patients (30.8 months) than in naïve patients (56.0 months) (B=0.766, HR=2.15 [95% CI: 0.062-0.903], p=0.018). Patients treated with intramuscular-INF-β-1A, subcutaneous-INF-β-1A, and fingolimod remained under treatment for longer (55.1, 50.2, and 49.2 months, respectively). The causes for discontinuation were “lack of effectiveness” (36.4%), “intolerance/adverse effects” (36.4%), “pregnancy/breastfeeding” (10.9%), “John Cunningham (JC) virus antibodies” (10.9%), and “contraindication for severe disease” (5.5%).
Conclusions: Persistence with DMT decreased over time and was higher for naïve than pretreated patients. INF-β-1A was the disease-modifying drug received by these MS patients for the longest time.
Key Words: Multiple sclerosis, persistence, immunomodulating treatment.