Long-Term Persistence with Injectable Therapy in Relapsing-Remitting Multiple Sclerosis: An 18-Year Observational Cohort Study

Disease modifying therapies (DMTs) reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS). Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults w...

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Published in:	PloS one Vol. 10; no. 4; p. e0123824
Main Authors:	Zhornitsky, Simon, Greenfield, Jamie, Koch, Marcus W., Patten, Scott B., Harris, Colleen, Wall, Winona, Alikhani, Katayoun, Burton, Jodie, Busche, Kevin, Costello, Fiona, Davenport, Jeptha W., Jarvis, Scott E., Lavarato, Dina, Parpal, Helene, Patry, David G., Yeung, Michael, Metz, Luanne M.
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 13.04.2015 Public Library of Science (PLoS)
Subjects:	Adult Adults Analysis Autoimmune diseases Biological response modifiers Cohort analysis Cohort Studies Copolymer 1 Diabetes Drug dosages Female Footprints Glatiramer Acetate - administration & dosage Hepatitis Humans Injections, Subcutaneous Interferon Interferon beta-1a - administration & dosage Interferon beta-1b - administration & dosage Male Medicine Middle Aged Multiple sclerosis Multiple Sclerosis, Relapsing-Remitting - drug therapy Neurosciences Nurses Observational studies Patients Population Population studies Pregnancy Rank tests Regression analysis Regression models Switches β-Interferon Canada United States > US Calgary Alberta Canada
ISSN:	1932-6203, 1932-6203
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Abstract	Disease modifying therapies (DMTs) reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS). Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults with relapsing-remitting MS who started either glatiramer acetate (GA) or interferon-β 1a/1b (IFN-β) between January 1st, 1996 and July 1st, 2011 were included. Follow-up continued to February 1st, 2014. Time-to-discontinuation of the initial and subsequently-prescribed DMTs (switches) was analysed using Kaplan-Meier survival analyses. Group differences were compared using log-rank tests and multivariable Cox regression models. Analysis included 1471 participants; 906 were initially prescribed GA and 565 were initially prescribed IFN-β. Follow-up information was available for 87%; 29 (2%) were lost to follow-up and 160 (11%) moved from Southern Alberta while still using DMT. Median time-to-discontinuation of all injectable DMTs was 11.1 years. Participants with greater disability at treatment initiation, those who started treatment before age 30, and those who started between 2006 and 2011 were more likely to discontinue use of all injectable DMTs. Median time-to-discontinuation of the initial DMT was 8.6 years. Those initially prescribed GA remained on treatment longer. Of 610 participants who discontinued injectable DMT, 331 (54%) started an oral DMT, or a second-line DMT, or resumed injectable DMT after 90 days. Persistence with injectable DMTs was high in this long-term population-based study. Most participants who discontinued injectable DMT did not remain untreated. Further research is required to understand treatment outcomes and outcomes after stopping DMT.
AbstractList	Disease modifying therapies (DMTs) reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS). Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults with relapsing-remitting MS who started either glatiramer acetate (GA) or interferon-β 1a/1b (IFN-β) between January 1st, 1996 and July 1st, 2011 were included. Follow-up continued to February 1st, 2014. Time-to-discontinuation of the initial and subsequently-prescribed DMTs (switches) was analysed using Kaplan-Meier survival analyses. Group differences were compared using log-rank tests and multivariable Cox regression models. Analysis included 1471 participants; 906 were initially prescribed GA and 565 were initially prescribed IFN-β. Follow-up information was available for 87%; 29 (2%) were lost to follow-up and 160 (11%) moved from Southern Alberta while still using DMT. Median time-to-discontinuation of all injectable DMTs was 11.1 years. Participants with greater disability at treatment initiation, those who started treatment before age 30, and those who started between 2006 and 2011 were more likely to discontinue use of all injectable DMTs. Median time-to-discontinuation of the initial DMT was 8.6 years. Those initially prescribed GA remained on treatment longer. Of 610 participants who discontinued injectable DMT, 331 (54%) started an oral DMT, or a second-line DMT, or resumed injectable DMT after 90 days. Persistence with injectable DMTs was high in this long-term population-based study. Most participants who discontinued injectable DMT did not remain untreated. Further research is required to understand treatment outcomes and outcomes after stopping DMT. Disease modifying therapies (DMTs) reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS). Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults with relapsing-remitting MS who started either glatiramer acetate (GA) or interferon-[beta] 1a/1b (IFN-[beta]) between January 1.sup.st, 1996 and July 1.sup.st, 2011 were included. Follow-up continued to February 1.sup.st, 2014. Time-to-discontinuation of the initial and subsequently-prescribed DMTs (switches) was analysed using Kaplan-Meier survival analyses. Group differences were compared using log-rank tests and multivariable Cox regression models. Analysis included 1471 participants; 906 were initially prescribed GA and 565 were initially prescribed IFN-[beta]. Follow-up information was available for 87%; 29 (2%) were lost to follow-up and 160 (11%) moved from Southern Alberta while still using DMT. Median time-to-discontinuation of all injectable DMTs was 11.1 years. Participants with greater disability at treatment initiation, those who started treatment before age 30, and those who started between 2006 and 2011 were more likely to discontinue use of all injectable DMTs. Median time-to-discontinuation of the initial DMT was 8.6 years. Those initially prescribed GA remained on treatment longer. Of 610 participants who discontinued injectable DMT, 331 (54%) started an oral DMT, or a second-line DMT, or resumed injectable DMT after 90 days. Persistence with injectable DMTs was high in this long-term population-based study. Most participants who discontinued injectable DMT did not remain untreated. Further research is required to understand treatment outcomes and outcomes after stopping DMT. Disease modifying therapies (DMTs) reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS). Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults with relapsing-remitting MS who started either glatiramer acetate (GA) or interferon-β 1a/1b (IFN-β) between January 1st, 1996 and July 1st, 2011 were included. Follow-up continued to February 1st, 2014. Time-to-discontinuation of the initial and subsequently-prescribed DMTs (switches) was analysed using Kaplan-Meier survival analyses. Group differences were compared using log-rank tests and multivariable Cox regression models. Analysis included 1471 participants; 906 were initially prescribed GA and 565 were initially prescribed IFN-β. Follow-up information was available for 87%; 29 (2%) were lost to follow-up and 160 (11%) moved from Southern Alberta while still using DMT. Median time-to-discontinuation of all injectable DMTs was 11.1 years. Participants with greater disability at treatment initiation, those who started treatment before age 30, and those who started between 2006 and 2011 were more likely to discontinue use of all injectable DMTs. Median time-to-discontinuation of the initial DMT was 8.6 years. Those initially prescribed GA remained on treatment longer. Of 610 participants who discontinued injectable DMT, 331 (54%) started an oral DMT, or a second-line DMT, or resumed injectable DMT after 90 days. Persistence with injectable DMTs was high in this long-term population-based study. Most participants who discontinued injectable DMT did not remain untreated. Further research is required to understand treatment outcomes and outcomes after stopping DMT.Disease modifying therapies (DMTs) reduce the frequency of relapses and accumulation of disability in multiple sclerosis (MS). Long-term persistence with treatment is important to optimize treatment benefit. This long-term, cohort study was conducted at the Calgary MS Clinic. All consenting adults with relapsing-remitting MS who started either glatiramer acetate (GA) or interferon-β 1a/1b (IFN-β) between January 1st, 1996 and July 1st, 2011 were included. Follow-up continued to February 1st, 2014. Time-to-discontinuation of the initial and subsequently-prescribed DMTs (switches) was analysed using Kaplan-Meier survival analyses. Group differences were compared using log-rank tests and multivariable Cox regression models. Analysis included 1471 participants; 906 were initially prescribed GA and 565 were initially prescribed IFN-β. Follow-up information was available for 87%; 29 (2%) were lost to follow-up and 160 (11%) moved from Southern Alberta while still using DMT. Median time-to-discontinuation of all injectable DMTs was 11.1 years. Participants with greater disability at treatment initiation, those who started treatment before age 30, and those who started between 2006 and 2011 were more likely to discontinue use of all injectable DMTs. Median time-to-discontinuation of the initial DMT was 8.6 years. Those initially prescribed GA remained on treatment longer. Of 610 participants who discontinued injectable DMT, 331 (54%) started an oral DMT, or a second-line DMT, or resumed injectable DMT after 90 days. Persistence with injectable DMTs was high in this long-term population-based study. Most participants who discontinued injectable DMT did not remain untreated. Further research is required to understand treatment outcomes and outcomes after stopping DMT.
Audience	Academic
Author	Davenport, Jeptha W. Alikhani, Katayoun Greenfield, Jamie Lavarato, Dina Wall, Winona Patry, David G. Zhornitsky, Simon Burton, Jodie Jarvis, Scott E. Metz, Luanne M. Patten, Scott B. Busche, Kevin Parpal, Helene Costello, Fiona Yeung, Michael Harris, Colleen Koch, Marcus W.
AuthorAffiliation	1 Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary; Calgary, Canada 2 Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Canada 3 Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, Canada Friedrich-Alexander University Erlangen, GERMANY
AuthorAffiliation_xml	– name: 1 Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary; Calgary, Canada – name: Friedrich-Alexander University Erlangen, GERMANY – name: 2 Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Canada – name: 3 Hotchkiss Brain Institute, Faculty of Medicine, University of Calgary, Calgary, Canada
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25867095$$D View this record in MEDLINE/PubMed
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: LMM CH SBP. Performed the experiments: SZ JG MWK CH WW KA JB KB FC JWD SEJ DL HP DGP MY LMM. Analyzed the data: LMM SZ MWK JG WW. Wrote the paper: SZ JG LMM.
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SubjectTerms	Adult Adults Analysis Autoimmune diseases Biological response modifiers Cohort analysis Cohort Studies Copolymer 1 Diabetes Drug dosages Female Footprints Glatiramer Acetate - administration & dosage Hepatitis Humans Injections, Subcutaneous Interferon Interferon beta-1a - administration & dosage Interferon beta-1b - administration & dosage Male Medicine Middle Aged Multiple sclerosis Multiple Sclerosis, Relapsing-Remitting - drug therapy Neurosciences Nurses Observational studies Patients Population Population studies Pregnancy Rank tests Regression analysis Regression models Switches β-Interferon
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Title	Long-Term Persistence with Injectable Therapy in Relapsing-Remitting Multiple Sclerosis: An 18-Year Observational Cohort Study
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