Chen Chao, Wu Ning, Watson Crystal
Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA.
Value and Access, Biogen, Cambridge, MA, USA,
Clinicoecon Outcomes Res. 2018 Nov 2;10:723-730. doi: 10.2147/CEOR.S163907. eCollection 2018.
Real-world outcomes from staying on an interferon beta (IFNβ) vs switching to another IFNβ could help guide treatment decisions. This study's objective was to compare outcomes of stable multiple sclerosis (MS) patients on an IFNβ who stayed on therapy vs those who switched to another IFNβ.
MS patients were identified from the Optum Insights Clinformatics Data Mart Multi-Plan who were 18-64 years old and relapse-free (stable) over 1 year while continuously being treated with an IFNβ. Patients were propensity score matched 3:1 using age, gender, initial IFNβ, adherence, and month and year for patients who stayed on the initial IFNβ (No Switch) to patients who switched to another IFNβ (Switch). Patients had to be continuously enrolled for 1 year prior to and 1 year after the index date (date of the first claim of the switched-to IFNβ or the match date when continuing on initial IFNβ treatment). Patients were enrolled with index dates between January 1, 2005 and September 30, 2014. Relapses were recorded during the 1-year follow-up period after index date.
After matching, there were 381 patients in the Switch group and 1,143 in the No Switch group. Baseline characteristics were well matched between groups (average age 46 years, 72% female). The percentage of patients experiencing a relapse during the follow-up was significantly higher in the Switch group than in the No Switch group (21% vs 12%, <0.0001). Annual relapse rate during the follow-up was significantly higher in the Switch group than in the No Switch group (0.35 vs 0.20, <0.0001).
MS patients stable on IFNβ therapy who remain on initial therapy had significantly better outcomes (lower annual relapse rate and percentage of patients with relapses) than patients who switched to another IFNβ. This supports the benefits of allowing patients to remain on current IFNβ therapy when stable.
持续使用干扰素β（IFNβ）与换用另一种IFNβ的实际疗效有助于指导治疗决策。本研究的目的是比较稳定型多发性硬化症（MS）患者持续使用IFNβ治疗与换用另一种IFNβ治疗的疗效。
从Optum Insights Clinformatics Data Mart Multi-Plan中识别出年龄在18至64岁之间、在1年以上时间内无复发（病情稳定）且持续接受IFNβ治疗的MS患者。使用年龄、性别、初始IFNβ、依从性以及初始IFNβ治疗组（未换药组）与换用另一种IFNβ治疗组（换药组）患者的月份和年份，将患者按倾向得分以3:1进行匹配。患者在索引日期（换用的IFNβ首次申请日期或继续初始IFNβ治疗的匹配日期）之前1年和之后1年必须持续入组。患者的索引日期在2005年1月1日至2014年9月30日之间。在索引日期后的1年随访期内记录复发情况。
匹配后，换药组有381例患者，未换药组有1143例患者。两组的基线特征匹配良好（平均年龄46岁，72%为女性）。随访期间出现复发的患者百分比在换药组显著高于未换药组（21%对12%，<0.0001）。随访期间的年复发率在换药组显著高于未换药组（0.35对0.20，<0.0001）。
IFNβ治疗病情稳定的MS患者继续初始治疗的疗效（年复发率和复发患者百分比更低）显著优于换用另一种IFNβ治疗的患者。这支持了在病情稳定时允许患者继续当前IFNβ治疗的益处。
