Warrender-Sparkes Matthew, Spelman Tim, Izquierdo Guillermo, Trojano Maria, Lugaresi Alessandra, Grand'Maison François, Havrdova Eva, Horakova Dana, Boz Cavit, Oreja-Guevara Celia, Alroughani Raed, Iuliano Gerardo, Duquette Pierre, Girard Marc, Terzi Murat, Hupperts Raymond, Grammond Pierre, Petersen Thor, Fernandez-Bolaños Ricardo, Fiol Marcela, Pucci Eugenio, Lechner-Scott Jeannette, Verheul Freek, Cristiano Edgardo, Van Pesch Vincent, Petkovska-Boskova Tatjana, Moore Fraser, Kister Ilya, Bergamaschi Roberto, Saladino Maria Laura, Slee Mark, Barnett Michael, Amato Maria Pia, Shaw Cameron, Shuey Neil, Young Carolyn, Gray Orla, Kappos Ludwig, Butzkueven Helmut, Kalincik Tomas, Jokubaitis Vilija
Department of Medicine, University of Melbourne, Melbourne, Australia.
Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.
Mult Scler. 2016 Apr;22(4):520-32. doi: 10.1177/1352458515594041. Epub 2015 Jul 21.
We aimed to analyse the effect of the introduction of fingolimod, the first oral disease-modifying therapy, on treatment utilisation and persistence in an international cohort of patients with multiple sclerosis (MS).
MSBASIS, a prospective, observational sub-study of the MSBase registry, collects demographic, clinical and paraclinical data on patients followed from MS onset (n=4718). We conducted a multivariable conditional risk set survival analysis to identify predictors of treatment discontinuation, and to assess if the introduction of fingolimod has altered treatment persistence.
A total of 2640 patients commenced immunomodulatory therapy. Following the introduction of fingolimod, patients were more likely to discontinue all other treatments (hazard ratio 1.64, p<0.001) while more patients switched to fingolimod than any other therapy (42.3% of switches). Patients switched to fingolimod due to convenience. Patients treated with fingolimod were less likely to discontinue treatment compared with other therapies (p<0.001). Female sex, country of residence, younger age, a high Expanded Disability Status Scale score and relapse activity were all independently associated with higher rates of treatment discontinuation.
Following the availability of fingolimod, patients were more likely to discontinue injectable treatments. Those who switched to fingolimod were more likely to do so for convenience. Persistence was improved on fingolimod compared to other medications.
我们旨在分析第一种口服疾病修正疗法芬戈莫德的引入对国际多发性硬化症（MS）患者队列中治疗使用情况和持续时间的影响。
MSBASIS是MSBase注册研究的一项前瞻性观察性子研究，收集了自MS发病起随访的患者的人口统计学、临床和辅助临床数据（n = 4718）。我们进行了多变量条件风险集生存分析，以确定治疗中断的预测因素，并评估芬戈莫德的引入是否改变了治疗持续时间。
共有2640名患者开始免疫调节治疗。芬戈莫德引入后，患者更有可能停止所有其他治疗（风险比1.64，p < 0.001），同时转向芬戈莫德治疗的患者比转向任何其他疗法的患者都多（占转换的42.3%）。患者因方便而转向芬戈莫德治疗。与其他疗法相比，接受芬戈莫德治疗的患者更不容易停止治疗（p < 0.001）。女性、居住国家、年龄较小、扩展残疾状态量表评分较高和复发活动均与较高的治疗中断率独立相关。
芬戈莫德上市后，患者更有可能停止注射治疗。转向芬戈莫德治疗的患者更有可能是因为方便。与其他药物相比，芬戈莫德治疗的持续时间有所改善。
