Gold Laura S, Suh Kangho, Schepman Patricia B, Damal Kavitha, Hansen Ryan N
Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA.
Department of Radiology, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA.
Adv Ther. 2016 Aug;33(8):1279-92. doi: 10.1007/s12325-016-0363-0. Epub 2016 Jun 17.
Multiple sclerosis (MS) is an autoimmune disorder with large annual costs. This study evaluated utilization and costs for the management of MS relapses with H.P. Acthar(®) Gel (repository corticotropin injection; Acthar; Mallinckrodt) compared to receipt of plasmapheresis (PMP) or intravenous immunoglobulin (IVIG) among patients with MS who experienced multiple relapses.
We identified patients with MS diagnoses who had relapses treated with intravenous methylprednisolone (IVMP), the first-line treatment for MS relapse. Patients who were treated for the subsequent relapses were eligible for the study. We analyzed 12- and 24-month healthcare utilization and costs among patients who received Acthar prescriptions compared to patients who were treated with PMP/IVIG using generalized linear and logistic regression models to calculate unadjusted and adjusted means and 95% confidence intervals.
For the 12-month analysis, a total of 213 patients received Acthar prescriptions and 226 were treated with PMP or IVIG. Patients who received Acthar prescriptions were similar to those who received other treatments in terms of most demographic variables. Acthar recipients had fewer hospitalizations (0.2 vs. 0.4; P = 0.01) and received fewer outpatient services (29 vs. 43; P < 0.0001) but received more prescription medications (36 vs. 30; P < 0.0001) compared to recipients of PMP/IVIG. Patients who received Acthar prescriptions had lower inpatient and outpatient costs ($15,000 lower; P = 0.001; and $54,000 lower; P < 0.0001, respectively) but similar total costs. Similar results were seen in the cohort with 24 months of outcome data.
Acthar may be a useful treatment option compared to PMP/IVIG for patients with MS experiencing multiple relapses.
This study was funded by a grant to the University of Washington from Mallinckrodt Pharmaceuticals.
多发性硬化症（MS）是一种自身免疫性疾病，每年花费巨大。本研究评估了在经历多次复发的MS患者中，使用H.P. Acthar（®）凝胶（促肾上腺皮质激素储存注射液；Acthar；马林克罗特公司）治疗MS复发的使用情况和成本，并与接受血浆置换（PMP）或静脉注射免疫球蛋白（IVIG）的情况进行比较。
我们确定了患有MS且复发时接受一线治疗药物静脉注射甲基泼尼松龙（IVMP）治疗的患者。接受后续复发治疗的患者符合本研究条件。我们分析了接受Acthar处方的患者与接受PMP/IVIG治疗的患者在12个月和24个月的医疗保健使用情况和成本，使用广义线性和逻辑回归模型计算未调整和调整后的均值以及95%置信区间。
在12个月的分析中，共有213名患者接受了Acthar处方，226名患者接受了PMP或IVIG治疗。在大多数人口统计学变量方面，接受Acthar处方的患者与接受其他治疗的患者相似。与接受PMP/IVIG的患者相比，接受Acthar处方的患者住院次数更少（0.2次对0.4次；P = 0.01），接受的门诊服务更少（29次对43次；P < 0.0001），但接受的处方药更多（36种对30种；P < 0.0001）。接受Acthar处方的患者住院和门诊成本更低（分别低15,000美元；P = 0.001；和低54,000美元；P < 0.0001），但总成本相似。在有24个月结局数据的队列中也观察到了类似结果。
对于经历多次复发的MS患者，与PMP/IVIG相比，Acthar可能是一种有用的治疗选择。
本研究由马林克罗特制药公司授予华盛顿大学的一项赠款资助。
