Allan Michelle, Grant Lindsay
Monash Health, Clayton, VIC, 3168, Australia.
Biogen, North Ryde, NSW, 2066, Australia.
Neurol Ther. 2020 Jun;9(1):85-92. doi: 10.1007/s40120-019-00174-3. Epub 2019 Dec 13.
The main objective of this study was to examine discontinuation rates associated with delayed-release dimethyl fumarate (DMF) when used for the treatment of relapsing multiple sclerosis (MS) in a real-world, clinical practice setting.
Data were collected retrospectively from charts of adult patients with relapsing-remitting MS treated at a single large institution in Australia, who completed at least 6 months of continuous therapy, either with DMF or another MS medication administered following DMF discontinuation. The primary endpoint was overall discontinuation rate. Secondary endpoints included discontinuation rate 6 months after initiation of DMF therapy; incidence of adverse events, particularly gastrointestinal events; discontinuation rate because of adverse events; and use of concomitant medications by patients during administration of DMF.
A total of 100 patients initially prescribed DMF between October 1, 2013 and June 30, 2014 were included in the analysis. The mean age of the patients was 43 years and 80% were female. The overall discontinuation rate was 13%, with 9% discontinuing because of gastrointestinal tolerability issues, within the first 6 months. Dose changes as a result of adverse events occurred in 15% of patients, and none of the adverse events reported were serious. Only one patient discontinued owing to lack of efficacy.
This study, conducted shortly after the approval of DMF in Australia when first-hand clinical experience was still limited, demonstrated that DMF has an acceptable tolerability profile in the real-world setting that is similar to that demonstrated in clinical trials.
本研究的主要目的是在真实临床实践环境中,考察用于治疗复发型多发性硬化症(MS)的缓释富马酸二甲酯(DMF)的停药率。
从澳大利亚一家大型机构接受治疗的复发缓解型MS成年患者病历中回顾性收集数据,这些患者完成了至少6个月的持续治疗,治疗药物为DMF或DMF停药后使用的其他MS药物。主要终点是总体停药率。次要终点包括DMF治疗开始后6个月的停药率;不良事件发生率,尤其是胃肠道事件;因不良事件导致的停药率;以及患者在使用DMF期间的伴随用药情况。
2013年10月1日至2014年6月30日期间最初处方DMF的100例患者纳入分析。患者的平均年龄为43岁,80%为女性。总体停药率为13%,其中9%在最初6个月内因胃肠道耐受性问题停药。15%的患者因不良事件发生剂量调整,报告的不良事件均不严重。仅1例患者因缺乏疗效停药。
本研究在澳大利亚批准DMF后不久进行,当时一手临床经验仍有限,结果表明DMF在真实环境中的耐受性与临床试验中显示的相似,是可接受的。