Long DMD Lapses Associated With Higher Relapses, Resource Use, and Costs

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Patients with multiple sclerosis with a lapse of >60 days of therapy may result in more lapses, resource use, and higher cost.

The following article is part of conference coverage from the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers , in Seattle, Washington. MPR‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2019.

SEATTLE — Compared with patients with multiple sclerosis (MS) without a lapse of over 60 days in treatment with once- or twice-daily oral disease-modifying drugs (DMDs), patients with a greater than 60-day lapse in therapy had more relapses, greater use of resources, and higher costs, according to research presented at the Consortium of Multiple Sclerosis Centers’ Annual Meeting, held May 28 to June 1, in Seattle, Washington.

This United States administrative claims study was used to describe lapses in DMD therapy and the clinical and economic outcomes for patients with MS receiving once- or twice-daily oral DMDs (dimethyl fumarate, fingolimod, teriflunomide), either with or without a lapse of over 60 days in treatment. Patients (aged 18 to 63) with continuous commercial insurance were identified by 2 or more MS diagnoses and 1 or more claims for a once- or twice-daily oral DMD between January 2011 and June 2015. Therapy lapses were defined as the number of days between the end of the prior prescription supply and the filling of a new DMD prescription. Patients with and without a greater than 60-day lapse in MS treatment were matched 1:1 using propensity score matching.

Of the 8779 eligible patients, 15.1% (n=1326) had a lapse of over 60 days over the course of 18 months and 84.9% (n=7453) did not. Mean treatment lapse duration for those with a lapse over 60 days was 143.3 (standard deviation, 94.2) days and for those without a greater than 60-day lapse was 17.6 (standard deviation, 13.9) days.  Mean age and gender between groups were similar. Patients with a greater than 60-day treatment lapse had 22.4% more outpatient visits than patients without such lapses (6.24 vs 4.84; P <.001), 24.6% more emergency room visits (0.61 vs 0.46; P =.010), 27.6% more relapses (mean 1.16 vs 0.84; P <.001), and 40.0% more hospitalizations (0.20 vs 0.12; P <.001). No differences in magnetic resonance imaging tests were observed (1.16 vs 1.14; P=.688). Nonmedication costs during the 18 months was 24.5% greater for patients experiencing treatment lapses greater than 60 days compared with those without such lapses ($16,012 vs $12,092; P =.001).

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Study investigators conclude, “Patients with [multiple sclerosis] receiving once- or twice-daily oral DMDs with a >60-day lapse in therapy had more relapses, resource use, and higher costs vs patients without a >60-day lapse over 18 months. These results highlight the need to address DMD treatment lapses, including use of DMDs with dosing regimens that may mitigate these negative consequences.”

Study investigators report connections to EMD Serono Inc [a business of Merck KGaA], Health Services Consulting Corporation, and Fair Dynamics Consulting.

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Nicholas JA, Edwards NC, Dellarole A, Harlow DE, Phillips AL. Relapses, health care resource use, and costs among patients with multiple sclerosis taking maintenance (once or twice daily) oral disease-modifying drugs and experiencing lapses in therapy. Presented at: The Consortium of Multiple Sclerosis Centers Annual Meeting; May 28-June 1, 2019; Seattle, WA. Abstract DXT32

This article originally appeared on Neurology Advisor