Division of Neurology, Department of Medicine, Faculty of Medicine, The Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, UBC Hospital, Vancouver, BC, Canada.
Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI, USA.
Mult Scler. 2021 Feb;27(2):239-249. doi: 10.1177/1352458520910500. Epub 2020 Mar 6.
To examine laboratory testing adherence by persons initiating an oral disease-modifying therapy (DMT) for multiple sclerosis (MS).
Population-based health administrative and laboratory data were accessed in British Columbia, Canada, to identify everyone filling their first prescription for dimethyl fumarate (DMF), fingolimod or teriflunomide (2011-2015). The proportion of people adherent to each drug monograph's recommended laboratory monitoring schedule, pre- and on-DMT, was estimated. The association between patient characteristics and adherence was examined using multivariable logistic regression.
A total of 1016 people were included (DMF 567, fingolimod 253 and teriflunomide 196). The proportions of people adherent to pre-DMT liver and lymphocyte tests ranged from 88% to 91% and 91% to 94%, respectively, while 77% adhered to pre-DMF urinalysis. Adherence to the first on-DMT liver test was 89% for DMF (within 6 months), 61% for fingolimod (within 3 months) and 40% for teriflunomide (within 1 month). Men were less likely than women to have pre-DMF urinalysis (adjusted odds ratio (aOR); 95% confidence interval (CI): 0.40-0.95) or on-DMF liver (aOR: 0.46; 95% CI: 0.23-0.95) or lymphocyte (aOR: 0.47; 95% CI: 0.22-0.98) tests.
Adherence to recommended laboratory testing was high (>77%) before oral DMT initiation, but lower once on drug. There is a need to understand the long-term consequences of suboptimal laboratory monitoring and sex differences in the DMT-treated MS population.
研究开始使用口服疾病修正疗法（DMT）治疗多发性硬化症（MS）的患者的实验室检测依从性。
在加拿大不列颠哥伦比亚省，利用基于人群的健康行政和实验室数据，确定每位患者首次使用二甲基富马酸（DMF）、芬戈莫德或特立氟胺的处方（2011-2015 年）。估计每种药物说明书推荐的实验室监测方案的患者比例，在开始 DMT 前和开始 DMT 后都进行了监测。使用多变量逻辑回归检查患者特征与依从性的关系。
共纳入 1016 例患者（DMF 567 例，芬戈莫德 253 例，特立氟胺 196 例）。开始 DMT 前的肝和淋巴细胞检测中，患者分别有 88%至 91%和 91%至 94%符合实验室检测要求，77%的患者进行了 DMF 尿分析。开始 DMT 后，DMF 的第一次肝检查的依从率为 89%（在 6 个月内），芬戈莫德为 61%（在 3 个月内），特立氟胺为 40%（在 1 个月内）。与女性相比，男性进行 DMF 尿分析（调整后的优势比（aOR）；95%置信区间（CI）：0.40-0.95）或 DMF 肝（aOR：0.46；95% CI：0.23-0.95）或淋巴细胞（aOR：0.47；95% CI：0.22-0.98）检测的可能性较低。
开始口服 DMT 前，实验室检测的依从性较高（>77%），但开始使用药物后则较低。需要了解实验室监测效果不佳的长期后果以及 DMT 治疗 MS 人群中的性别差异。
