Ha-Vinh Philippe, Nauleau Stève, Clementz Marine, Régnard Pierre, Sauze Laurent, Clavaud Henri
Régime Social des Indépendants RSI, 13002 Marseille, France.
Agence Régionale de Santé ARS, 13002 Marseille, France.
Presse Med. 2019 Jan;48(1 Pt 1):e1-e19. doi: 10.1016/j.lpm.2018.04.013. Epub 2018 Dec 7.
Multiple sclerosis (MS) disease modifying therapies (DMT) utilization increased during the last decade with the approval of new drugs. Symptomatic treatments also play an important role. Describing time trends and demographic characteristics for DMT and symptomatic treatments utilization in population-based MS patients will lead to a better knowledge of the resources distribution.
Repeated cross-sectional analysis on each calendar year were implemented retrospectively on the health insurance claims database in France from 2013 until 2015 regarding DMT, fampridine, fluoxetine, psychiatrist office visits, and Physical therapy sessions to calculate an utilization rate defined as the number of MS patients (whenever the date of diagnosis) who filled at least 1 prescription or service within the studied calendar year per cent MS patients covered the same calendar year (number of users per cent MS population per annum). Beneficiaries with MS were identified by their exemption of co-payment for long-term disease (ALD).
DMT utilization rate increased from 34.22% in 2013 to 38.73% in 2015. The increase was due to recently developed DMT as first-generation DMT utilization rate decreased from 30.20% to 20.06%. Rates were not different between genders but significantly decreased with age. The average age of users was significantly lower for DMT than for symptomatic treatments (recently developed DMT: 43.63, first-generation DMT: 45.84, psychiatrist office visits: 49.08, Fampyra: 55.41, Physical therapy sessions: 55.88, fluoxetine: 58.26). Regional DMT utilization rates ranged from 31.68% in Auvergne-Rhône-Alpes to 42.58% in Normandie. They were not correlated to regional rates of MS prevalence (R-Square=0.0558; P=0.2556) nor to the presence of a MS reference centre in the region (Chi-Square=0.0190; P=0.8905). In 2015 the six DMTs with the highest rates were by decreasing orders: Tecfidera, Avonex, Gilenya, Aubagio, Copaxone, and Rebif. Half of them were recently developed orally-administered drugs.
Complex factors may explain the interprovincial variability. Low DMT utilization rates in the most aged patients who also have the highest recourse rate to symptomatic treatments reflect the fact that the indication of disease modifying therapies do not address older patient's needs. New DMTs with medical indications for the late degenerative phase are needed.
在过去十年中，随着新药获批，多发性硬化症（MS）疾病修正疗法（DMT）的使用有所增加。对症治疗也发挥着重要作用。描述基于人群的MS患者中DMT和对症治疗的使用时间趋势及人口统计学特征，将有助于更好地了解资源分配情况。
对法国2013年至2015年医疗保险理赔数据库进行回顾性分析，对每个日历年进行重复横断面分析，涉及DMT、氨吡啶、氟西汀、精神科门诊就诊和物理治疗疗程，以计算使用率，定义为在研究日历年中至少开具1份处方或接受1次服务的MS患者数量（无论诊断日期）占同年覆盖的MS患者百分比（每年用户数占MS人群百分比）。患有MS的受益人通过其长期疾病（ALD）共付豁免来识别。
DMT使用率从2013年的34.22%增至2015年的38.73%。增长归因于近期研发的DMT，因为第一代DMT使用率从30.20%降至20.06%。性别间使用率无差异，但随年龄显著下降。DMT使用者的平均年龄显著低于对症治疗使用者（近期研发的DMT：43.63，第一代DMT：45.84，精神科门诊就诊：49.08，氨吡啶：55.41，物理治疗疗程：55.88，氟西汀：58.26）。地区DMT使用率从奥弗涅 - 罗讷 - 阿尔卑斯的31.68%到诺曼底的42.58%不等。它们与地区MS患病率（R平方 = 0.0558；P = 0.2556）以及该地区是否存在MS参考中心（卡方 = 0.0190；P = 0.8905）均无相关性。2015年使用率最高的六种DMT按降序排列为：特立氟胺、阿沃尼单抗、吉列替尼、奥巴捷、考帕松和利比。其中一半是近期研发的口服药物。
复杂因素可能解释省际差异。年龄最大的患者DMT使用率低，而他们对症治疗的求助率最高，这反映出疾病修正疗法的适应症未满足老年患者的需求。需要有针对晚期退行性阶段医学适应症的新型DMT。
