The University of Texas at Austin, Austin, TX.
J Manag Care Spec Pharm. 2021 Jul;27(7):915-923. doi: 10.18553/jmcp.2021.27.7.915.
For multiple sclerosis (MS) patients taking disease-modifying therapies (DMTs), adherence to treatment is a key component of achieving beneficial outcomes, such as delayed disease progression and the reduction and prevention of symptoms and relapses. The aim of this study was to assess the impact of a claims-based measure of MS disease severity on DMT adherence in a one-year study period. Patients were identified from Humana Medicare Advantage claims data from January 1, 2013 to December 31, 2015. Patients over the age of 18 with at least 12 months of continuous enrollment and > 1 outpatient MS visit with DMT use prior to the index date were included. Patients who switched DMT type (oral, platform, IV) during the study period were excluded. Medication possession ratios (MPR) for DMTs were calculated from pharmacy and medical claims over 12 months of claims data, and a previously developed claims algorithm was used to determine MS disease severity. Patients with MPRs of 0.8 or higher were considered adherent to DMT treatment. Multivariable logistic regression was used to evaluate the association of MS disease severity, gender, DMT type, and age category with DMT adherence. The study population of 3,347 patients had an average MPR of 84.7 (75% were classified as adherent). Multivariable logistic analysis demonstrated that compared to the 18-45 age group, the 46-64 and 65+ age groups were 1.33 (OR: 1.33 [95% CI 1.08-1.64]) and 1.55 (OR: 1.55, [95% CI 1.18-2.05]) times more likely to be adherent. Patients with a high level of MS disease severity were 53% (OR: 0.47, [95% CI 0.36-0.62]) less likely to be adherent compared to those with low MS disease severity. No significant difference was identified for gender or DMT type (oral, platform, or IV). Increased age and lower MS disease severity were associated with better DMT adherence. MS disease severity should be considered when assessing risk for low DMT adherence. No funding supported this project. The authors have nothing to disclose. Preliminary results were previously presented virtually at AMCP Annual 2020 in April 2020.
对于多发性硬化症（MS）患者接受的疾病修正疗法（DMT），坚持治疗是实现有益结果的关键组成部分，例如延迟疾病进展以及减少和预防症状和复发。本研究旨在评估基于索赔的 MS 疾病严重程度衡量标准对为期一年的研究期间 DMT 依从性的影响。患者是从 Humana Medicare Advantage 的索赔数据中确定的，数据时间为 2013 年 1 月 1 日至 2015 年 12 月 31 日。年龄在 18 岁以上，至少有 12 个月的连续参保和索引日期前> 1 次门诊 MS 就诊并使用 DMT 的患者被纳入研究。在研究期间转换 DMT 类型（口服、平台、IV）的患者被排除在外。从药房和医疗索赔中计算了 12 个月的索赔数据中 DMT 的药物使用量（MPR），并使用了先前开发的索赔算法来确定 MS 疾病的严重程度。MPR 为 0.8 或更高的患者被认为坚持 DMT 治疗。多变量逻辑回归用于评估 MS 疾病严重程度、性别、DMT 类型和年龄类别与 DMT 依从性之间的关联。3347 名患者的研究人群的平均 MPR 为 84.7（75%被归类为依从）。多变量逻辑分析表明，与 18-45 岁年龄组相比，46-64 岁和 65 岁以上年龄组的依从性分别高出 1.33 倍（OR：1.33[95%CI 1.08-1.64]）和 1.55 倍（OR：1.55[95%CI 1.18-2.05]）。疾病严重程度较高的患者的依从性降低了 53%（OR：0.47[95%CI 0.36-0.62]）。与疾病严重程度较低的患者相比，性别或 DMT 类型（口服、平台或 IV）无显着差异。较高的年龄和较低的 MS 疾病严重程度与更好的 DMT 依从性相关。在评估 DMT 低依从性的风险时，应考虑 MS 疾病的严重程度。本项目无资金支持。作者没有要披露的内容。初步结果先前于 2020 年 4 月在 AMCP 年度 2020 年的虚拟会议上进行了介绍。
