Real-world persistence of multiple sclerosis disease-modifying therapies

Emma C Tallantyre^{1

2}, Ruth Dobson^{3

4}, Joseph L J Froud^{1

5}, Frederika A St John¹, Valerie M Anderson¹, Tarunya Arun⁶, Lauren Buckley⁷, Nikos Evangelou^{8

9}, Helen L Ford^{10

11}, Ian Galea^{12

13}, Sumi George¹⁴, Orla M Gray¹⁴, Aimee M Hibbert⁸, Mo Hu¹⁵, Stella E Hughes¹⁶, Gillian Ingram¹⁵, Seema Kalra¹⁷, Chia-Hui E Lim¹³, Joela T M Mathews¹⁸, Gavin V McDonnell¹⁶, Naomi Mescall¹⁹, Sam Norris²⁰, Stephen J Ramsay¹⁶, Claire M Rice^{7

21}, Melanie J Russell¹⁰, Marianne J Shawe-Taylor¹⁹, Thomas E Williams^{19

22}, Katharine E Harding²⁰, Neil P Robertson^{1

2}

Affiliations

¹ Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
² Department of Neurology, University Hospital of Wales, Cardiff, UK.
³ Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University London, London, UK.
⁴ Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
⁵ Postgraduate Department, St Thomas' Hospital, London, UK.
⁶ Department of Neuroscience, University Hospitals Coventry and Warwickshire, Coventry, UK.
⁷ Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
⁸ Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Queen's Medical Centre, University Hospitals NHS Trust, Nottingham, UK.
⁹ University of Nottingham, Nottingham, UK.
¹⁰ Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
¹¹ Faculty of Medicine and Health, University of Leeds, Leeds, UK.
¹² Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹³ Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁴ Department of Neurology, Ulster Hospital, Dundonald, UK.
¹⁵ Department of Neurology, Swansea University Health Board, Swansea, UK.
¹⁶ MS Clinic, Belfast City Hospital, Belfast, UK.
¹⁷ Neurology Department, University Hospital North Midlands NHS Trust, Stoke-on-Trent, UK.
¹⁸ Barts Health NHS Trust, London, UK.
¹⁹ Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK.
²⁰ Aneurin Bevan University Health Board, Department of Neurology, Royal Gwent Hospital, Newport, UK.
²¹ Transplantation Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
²² Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London, UK.

PMID: 38567516
PMCID: PMC11235620
DOI: 10.1111/ene.16289

Real-world persistence of multiple sclerosis disease-modifying therapies

Emma C Tallantyre et al. Eur J Neurol. 2024 Jul.

. 2024 Jul;31(7):e16289.

doi: 10.1111/ene.16289. Epub 2024 Apr 3.

Authors

Affiliations

¹ Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
² Department of Neurology, University Hospital of Wales, Cardiff, UK.
³ Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University London, London, UK.
⁴ Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
⁵ Postgraduate Department, St Thomas' Hospital, London, UK.
⁶ Department of Neuroscience, University Hospitals Coventry and Warwickshire, Coventry, UK.
⁷ Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
⁸ Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Queen's Medical Centre, University Hospitals NHS Trust, Nottingham, UK.
⁹ University of Nottingham, Nottingham, UK.
¹⁰ Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
¹¹ Faculty of Medicine and Health, University of Leeds, Leeds, UK.
¹² Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
¹³ Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁴ Department of Neurology, Ulster Hospital, Dundonald, UK.
¹⁵ Department of Neurology, Swansea University Health Board, Swansea, UK.
¹⁶ MS Clinic, Belfast City Hospital, Belfast, UK.
¹⁷ Neurology Department, University Hospital North Midlands NHS Trust, Stoke-on-Trent, UK.
¹⁸ Barts Health NHS Trust, London, UK.
¹⁹ Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK.
²⁰ Aneurin Bevan University Health Board, Department of Neurology, Royal Gwent Hospital, Newport, UK.
²¹ Transplantation Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
²² Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London, UK.

PMID: 38567516
PMCID: PMC11235620
DOI: 10.1111/ene.16289

Abstract

Background and purpose: Treatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real-world rates of persistence on disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation.

Methods: Treatment data on 4366 consecutive people with relapse-onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan-Meier survival analyses were used to express DMT persistence.

Results: In 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1-4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate.

Conclusions: Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.

Keywords: disease‐modifying therapy; multiple sclerosis; persistence; treatment.

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Conflict of interest statement

C.M.R. has received research funding from Sanofi. E.C.T. has received honoraria for consulting work, or speaker fees, from Biogen, Janssen, Merck, Novartis, and Roche, and has received travel grants to attend or speak at educational meetings from Biogen, Merck, Roche, and Novartis. G.I. has received honoraria for consulting work, or speaker fees, from Biogen, Novartis, and Roche, and has received travel grants to attend or speak at educational meetings from Biogen, Merck, Roche, and Novartis. H.L.F. has received honoraria for consulting work and/or educational activities from Biogen, Merck, Novartis, Roche, Sanofi Genzyme, and Teva. I.G. has received a research grant from Merck‐Serono. J.T.M.M. has received honoraria for consulting work, or speaker fees, from Biogen, Celegene BMS, Janssen, Merck, Novartis, Roche, Sandoz, and Sanofi. She has received travel grants to attend or speak at educational meetings from Biogen, Janssen, Merck, Novartis, Roche, Sandoz, and Sanofi. K.E.H. has received honoraria for consulting work, or speaker fees, from Biogen, Merck, and Roche, and has received travel grants to attend or speak at educational meetings from Biogen, Merck, Roche, and Novartis. M.J.R. has received speaker fees from Biogen. O.M.G. has received honoraria as a consultant on scientific advisory boards for Genzyme, Biogen, Merck, Roche, and Novartis; has received travel grants from Biogen, Merck, Roche, Sanofi, and Novartis; has participated in clinical trials by Biogen; and has received research funding from Biogen. R.D. has received educational/personal honoraria (to her organization) from Roche, Novartis, Sandoz, Biogen, and Merck, and research funding from Biogen and Merck. S.E.H. has received honoraria for consulting work, or speaker fees, from Biogen, Merck, Novartis, and Roche. She has received travel grants to attend conferences from Biogen, Merck, Roche, and Novartis. S.K. has received honoraria for consulting work from Biogen and Novartis. She has received travel grants to attend or speak at educational meetings from Biogen and Novartis. T.A. has received honoraria for advisory work, speaker fees, or research grants from Biogen, Merck, Novartis, Roche, and Janssen. T.E.W. has received honoraria for educational talks from Novartis and Merck. None of the other authors has any conflict of interest to disclose.

Figures

**FIGURE 1**
Schematic diagram illustrating the UK year of approval of each disease‐modifying therapy during the study period.

**FIGURE 2**
Study design. DMT, disease‐modifying therapy.

**FIGURE 3**
Kaplan–Meier survival curves illustrating cumulative persistence on disease‐modifying therapy (DMT) from time of commencement of treatment, by DMT.

**FIGURE 4**
Bar chart showing the percentage of reasons for discontinuation of disease‐modifying therapy (DMT), by DMT.

See this image and copyright information in PMC

References

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Real-world persistence of multiple sclerosis disease-modifying therapies

Affiliations

Real-world persistence of multiple sclerosis disease-modifying therapies

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources