United BioSource Corporation, Lexington, MA, USA.
Curr Med Res Opin. 2010 Mar;26(3):663-74. doi: 10.1185/03007990903554257.
This retrospective database study aimed to evaluate the adherence of multiple sclerosis (MS) patients on immunomodulatory treatments using claims data, and to identify differences between compliance and persistency measurements in the context of this disease.
Continuously enrolled MS patients treated with subcutaneous IFNbeta-1b (Betaseron * ), subcutaneous IFNbeta-1a (Rebif dagger ), intramuscular IFNbeta-1a (Avonex double dagger ), and subcutaneous glatiramer acetate (Copaxone section sign ).) were identified from the PharMetrics patient-centric database, and all information related to patient demographics and pharmacy claims for the drugs of interest were extracted.
The main outcomes were treatment switches and discontinuations for patients initiated on the drugs of interest. Various compliance and persistency metrics including the proportion of days covered, treatment prevalence at 6-monthly time points after initiation, and the continuous time on drug were also examined.
A total of 6134 MS patients were started on one of the four drugs of interest. The number of patients switching or discontinuing therapy rose over the study period. The proportion of patients switching was similar between study drugs, by the different metrics, with the highest switch rates for subcutaneous IFNbeta-1b and the lowest for subcutaneous glatiramer acetate. Discontinuation rates were highest for subcutaneous IFNbeta-1b and lowest for intramuscular IFNbeta-1a. Regression models showed that intramuscular IFNbeta-1a and subcutaneous IFNbeta-1a had similar and higher persistency compared to subcutaneous IFNbeta-1b and subcutaneous glatiramer acetate.
Although treatment switching and discontinuation is common in MS patients, there is some noticeable variability between drugs and across measures of persistency and adherence. Also, claims data do not allow distinguishing between clinical patterns of MS, direct estimation of disease severity and observation of care that occurs outside of insurance coverage, and results need to be cautiously interpreted. The compliance to the various MS drugs was 80% or higher at all times for all four drugs. The highest rate of treatment persistency existed in the intramuscular IFNbeta-1a initiator group, while subcutaneous IFNbeta-1b was associated with a significantly lower persistence (p < 0.0001).
本回顾性数据库研究旨在使用索赔数据评估多发性硬化症（MS）患者对免疫调节治疗的依从性，并确定在该疾病背景下，依从性和持久性测量之间的差异。
从 PharMetrics 以患者为中心的数据库中确定接受皮下注射 IFNbeta-1b（Betaseron*）、皮下注射 IFNbeta-1a（Rebif 剑）、肌肉内注射 IFNbeta-1a（Avonex 双剑）和皮下注射聚甘酯（Copaxone 斜杠）治疗的连续入组 MS 患者，并提取与患者人口统计学和药物相关的所有信息。
共有 6134 名 MS 患者开始使用四种药物中的一种。在研究期间，开始治疗的患者中，药物转换和停药的人数不断增加。所研究药物的各种依从性和持久性指标，包括覆盖天数的比例、治疗起始后 6 个月时的治疗流行率和连续用药时间，也进行了检查。
尽管 MS 患者的药物转换和停药很常见，但不同药物之间以及在持久性和依从性的衡量标准之间存在一些明显的差异。此外，索赔数据不允许区分 MS 的临床模式、直接估计疾病的严重程度和观察保险覆盖范围之外的护理情况，因此结果需要谨慎解释。在所有四种药物中，所有药物的依从性在任何时候都达到 80%或更高。肌肉内 IFNbeta-1a 起始组的治疗持久性最高，而皮下 IFNbeta-1b 与显著较低的持久性相关（p < 0.0001）。
