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Adherence to Multiple Sclerosis Disease-Modifying Therapies in Ontario is Low

Published online by Cambridge University Press:  02 December 2014

Janice Wong ,
Tara Gomes ,
Muhammad Mamdani ,
Michael Manno  and
Paul W. O'Connor
Janice Wong
Affiliation:
Division of Neurology, The Leslie Dan Faculty of Pharmacy
Tara Gomes
Affiliation:
St. Michael's Hospital, The Leslie Dan Faculty of Pharmacy Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
Muhammad Mamdani
Affiliation:
Department of Medicine, The Leslie Dan Faculty of Pharmacy Keenan Research Centre of the Li Ka-Shing Knowledge Institute, The Leslie Dan Faculty of Pharmacy Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada King Saud University, Riyadh, Saudi Arabia
Michael Manno
Affiliation:
St. Michael's Hospital, The Leslie Dan Faculty of Pharmacy Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
Paul W. O'Connor*
Affiliation:
Division of Neurology, The Leslie Dan Faculty of Pharmacy
*
Paul O’Connor, 30 Bond Street, Suite 3-007 Shuter Wing, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
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Abstract

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Background/Objective:

Differences in patient adherence to various disease-modifying drugs (DMDs) in the treatment of multiple sclerosis (MS) are not well understood. The goal of this study was to evaluate adherence of adult MS patients in Ontario with public drug plan coverage to various DMDs: intramuscular interferon beta-1a (i.m. IFNβ-1a, Avonex), subcutaneous interferon beta-1a (s.c. IFNβ-1a, Rebif), subcutaneous interferon beta-1b (IFNβ-1b, Betaseron) or glatiramer acetate (Copaxone).

Methods:

In this retrospective cohort study, Ontario Public Drug Plan beneficiaries aged 15 or older who were newly treated with i.m. IFNβ-1a, s.c. IFNβ-1a, IFNβ-1b or glatiramer acetate between April 2006 and March 2008 were followed forward until treatment discontinuation, switch to another DMD or a maximum two year follow-up period. Cumulative persistence rates were analyzed by the Kaplan-Meier method. The proportion of patients reaching the study endpoints after the two year follow-up period was also calculated.

Results:

Cumulative persistence rates for all four DMDs were similar over time (p=0.80), ranging from 73.6-79.1% at six months, 59.1-63.1% at one year and 41.5-47.4% at two years. After two years, the proportion of patients who had discontinued treatment, switched to another DMD or died was similar among DMDs (p=0.79, Fisher's exact test). Switching between DMD types was low and occurred in 3.4-6.5% of new DMD users.

Conclusions:

Adherence to DMDs in adult MS patients in Ontario is poor, which is consistent with previously reported adherence rates to MS DMDs in other regions. No significant differences in adherence exist between the DMDs evaluated in this study.

Résumé:

Résumé:Contexte et objectif:

Les differences dans la fidelite des patients aux differents traitements de fond (TF) utilises dans le traitement de la sclerose en plaques (SP) sont mal comprises. Le but de cette etude etait d’evaluer la fidelite au traitement chez des patients adultes atteints de SP en Ontario ou le plan publique d’assurance-medicament couvre differents TF : l’interferon beta-1a par voie intramusculaire (IFNβ-1a i.m., Avonex), l’interferon beta-1a par voie sous-cutanee (IFNβ-1a s.c., Rebif), l’interferon beta-1b par voie sous-cutanee (IFNβ-1b, Betaseron) et l’acetate de glatiramere (Copaxone).

Méthode:

Il s’agit d’une etude retrospective de cohorte portant sur les beneficiaires du Ontario Public Drug Plan, ages de 15 ans et plus, qui ont commence un traitement par l’IFNβ-1a i.m., l’IFNβ-1a s.c., l’IFNβ-1b ou l’acetate de glatiramere entre avril 2006 et mars 2008 et qui ont ete suivis jusqu’a l’arret du traitement, la substitution d’un autre TF ou pendant une periode maximum de deux ans. Les taux de persistance cumulatifs ont ete analyses par la methode de Kaplan-Meier. La proportion de patients qui rencontraient les criteres d’evaluation de l’etude apres deux ans de suivi a egalement ete calculee.

Résultats:

Les taux de persistance cumulatifs pour les 4 TF etaient similaires au cours de la duree de l’etude (p = 0,80), allant de 73,6% a 79,1% apres 6 mois, 59,1% a 63,1% apres 1 an et 41,5% a 47,4% apres 2 ans. La proportion des patients qui avaient cesse le traitement, poursuivi le traitement avec un autre TF ou etaient decedes etait similaire apres 2 ans, quelque soit le TF (p = 0,79 ; Fisher's exact test). Le taux de substitution d’un type de TF par un autre etait faible, soit de 3,4% a 6,5% chez les utilisateurs de TF.

Conclusion:

La fidelite aux TF chez les patients adultes atteints de SP en Ontario est faible et elle est comparable aux taux de fidelite au traitement rapportes anterieurement dans d’autres regions. Nous n’avons pas constate de difference significative dans la fidelite au traitement pour les TF evalues dans cette etude.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 429 - 433
Copyright
Copyright © The Canadian Journal of Neurological 2011

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