Persistence to disease-modifying therapies for multiple sclerosis in a Canadian cohort
Autor: | Charity Evans, Dessalegn Y. Melesse, Ruth Ann Marrie, James F. Blanchard, Bo Nancy Yu |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
medicine.medical_specialty
Population Medicine (miscellaneous) Disease Persistence (computer science) 03 medical and health sciences 0302 clinical medicine administrative data Interquartile range Internal medicine medicine adherence 030212 general & internal medicine Glatiramer acetate education Pharmacology Toxicology and Pharmaceutics (miscellaneous) Original Research education.field_of_study business.industry Health Policy Multiple sclerosis medicine.disease 3. Good health Discontinuation Patient Preference and Adherence Cohort Physical therapy drug utilization business 030217 neurology & neurosurgery Social Sciences (miscellaneous) discontinuation medicine.drug |
Zdroj: | Patient preference and adherence |
ISSN: | 1177-889X |
Popis: | Dessalegn Y Melesse,1,2 Ruth Ann Marrie,2,3 James F Blanchard,1 Bo Nancy Yu,1,4 Charity Evans5 1Centre for Global Public Health, 2Department of Community Health Sciences, 3Department of Internal Medicine, University of Manitoba, 4Public Health, Manitoba Health Seniors and Active Living, Winnipeg, Manitoba, 5College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Purpose: To examine the long-term persistence to the first-line injectable disease-modifying therapies (DMTs) for multiple sclerosis (MS) and to identify the factors associated with nonpersistence. Patients and methods: We used population-based administrative data from Manitoba, Canada. All adult subjects who were diagnosed with MS and dispensed a first-line injectable DMT (beta-interferon-1b, beta-interferon-1a, and glatiramer acetate) between 1996 and 2011 and had a minimum of 1 year of follow-up were included. The primary outcome was the median time to discontinuation of any DMT. The associations between potential predictors and persistence were estimated using multivariable Cox-proportional hazard models. Results: Overall, 721 subjects were followed for a median of 7.8 years (interquartile range 6.1). The median time to discontinuation of all first-line DMTs was 4.2 years (25th and 75th percentile: 1.7, 10.6 years). Of the 451 (62.6%) subjects who discontinued their DMT during the study period, 259 (57.4%) eventually resumed or restarted a DMT. Subjects who were younger when starting a DMT, had prior MS-related hospitalizations, were more recently diagnosed with MS, or had a greater lag time between their MS diagnosis and DMT initiation were more likely to discontinue therapy. Conclusion: Over half of the individuals receiving a DMT for MS in Manitoba remained on therapy for at least 4 years. DMT discontinuation occurred in 60% of the cohort, but most restarted a DMT within 1 year. While not all of the factors identified with discontinuing DMT are modifiable, they may help practitioners enhance MS care by identifying individuals who may be at particular risk for DMT discontinuation. Keywords: drug utilization, discontinuation, adherence, administrative data |
Databáze: | OpenAIRE |
Externí odkaz: |