Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors
Abstract Background Effective interventions for Multiple Sclerosis require timely treatment optimization which usually involves switching disease modifying therapies. The patterns of prescription and the reasons for changing treatment in people with MS, especially in low prevalence populations, are...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-024-03594-3 |
| _version_ | 1827291434960551936 |
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| author | Simón Cárdenas-Robledo Laura Estefanía Arenas-Vargas Rubén Darío Arenas Jorge Mario Gaspar-Toro Ángela María Muñoz-Rosero Aranza Helena Tafur-Borrero Daniel Stiven Marín-Medina Hernan Andrés Acosta-Fajardo Claudia Guío-Sánchez Lorena López-Reyes |
| author_facet | Simón Cárdenas-Robledo Laura Estefanía Arenas-Vargas Rubén Darío Arenas Jorge Mario Gaspar-Toro Ángela María Muñoz-Rosero Aranza Helena Tafur-Borrero Daniel Stiven Marín-Medina Hernan Andrés Acosta-Fajardo Claudia Guío-Sánchez Lorena López-Reyes |
| author_sort | Simón Cárdenas-Robledo |
| collection | DOAJ |
| description | Abstract Background Effective interventions for Multiple Sclerosis require timely treatment optimization which usually involves switching disease modifying therapies. The patterns of prescription and the reasons for changing treatment in people with MS, especially in low prevalence populations, are unknown. Objectives To describe the persistence, reasons of DMT switches and prescription patterns in a cohort of Colombian people with MS. Methods We conducted a retrospective observational study including patients with confirmed MS with at least one visit at our centre. We estimated the overall incidence rate of medication changes and assessed the persistence on medication with Kaplan–Meier survival estimates for individual medications and according to efficacy and mode of administration. The factors associated with changing medications were assessed using adjusted Cox proportional-hazards models. The reasons for switching medication changes were described, and the prescription patterns were assessed using network analysis, with measures of centrality. Results Seven hundred one patients with MS were included. Mean age was 44.3 years, and 67.9% were female. Mean disease duration was 11.3 years and 84.5% had relapsing MS at onset, with median EDSS of 1.0. Treatment was started in 659 (94%) of the patients after a mean of 3 years after MS symptom onset. Among them, 39.5% maintained their initial DMT, 29.9% experienced a single DMT change, while 18.7% went through two, and 11.9% had three or more DMT changes until the final follow-up. The total number of treatment modifications reached 720, resulting in an incidence rate of 1.09 (95% confidence interval: 1.01–1.17) per patient per year The median time to change after the first DMT was 3.75 years, and was not different according to the mode of administration or efficacy classification. The main reasons for changing DMT were MS activity (relapses, 56.7%; MRI activity, 18.6%), followed by non-serious adverse events (15.3%) and disability (11.1%). Younger age at MS onset, care under our centre and insurer status were the main determinants of treatment change. Network analysis showed that interferons and fingolimod were the most influential DMTs. Conclusions A majority of patients switch medications, mostly due to disease activity, and in association with age and insurer status. |
| first_indexed | 2024-04-24T12:38:03Z |
| format | Article |
| id | doaj.art-224e7530d5a14664a311fb41827a1241 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-24T12:38:03Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-224e7530d5a14664a311fb41827a12412024-04-07T11:22:22ZengBMCBMC Neurology1471-23772024-04-0124111010.1186/s12883-024-03594-3Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factorsSimón Cárdenas-Robledo0Laura Estefanía Arenas-Vargas1Rubén Darío Arenas2Jorge Mario Gaspar-Toro3Ángela María Muñoz-Rosero4Aranza Helena Tafur-Borrero5Daniel Stiven Marín-Medina6Hernan Andrés Acosta-Fajardo7Claudia Guío-Sánchez8Lorena López-Reyes9Centro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de ColombiaCentro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de ColombiaDepartamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de ColombiaDepartamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de ColombiaDepartamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de ColombiaDepartamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de ColombiaDepartamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de ColombiaDepartamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de ColombiaCentro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de ColombiaCentro de Esclerosis Múltiple (CEMHUN), Departamento de Neurología, Hospital Universitario Nacional de ColombiaAbstract Background Effective interventions for Multiple Sclerosis require timely treatment optimization which usually involves switching disease modifying therapies. The patterns of prescription and the reasons for changing treatment in people with MS, especially in low prevalence populations, are unknown. Objectives To describe the persistence, reasons of DMT switches and prescription patterns in a cohort of Colombian people with MS. Methods We conducted a retrospective observational study including patients with confirmed MS with at least one visit at our centre. We estimated the overall incidence rate of medication changes and assessed the persistence on medication with Kaplan–Meier survival estimates for individual medications and according to efficacy and mode of administration. The factors associated with changing medications were assessed using adjusted Cox proportional-hazards models. The reasons for switching medication changes were described, and the prescription patterns were assessed using network analysis, with measures of centrality. Results Seven hundred one patients with MS were included. Mean age was 44.3 years, and 67.9% were female. Mean disease duration was 11.3 years and 84.5% had relapsing MS at onset, with median EDSS of 1.0. Treatment was started in 659 (94%) of the patients after a mean of 3 years after MS symptom onset. Among them, 39.5% maintained their initial DMT, 29.9% experienced a single DMT change, while 18.7% went through two, and 11.9% had three or more DMT changes until the final follow-up. The total number of treatment modifications reached 720, resulting in an incidence rate of 1.09 (95% confidence interval: 1.01–1.17) per patient per year The median time to change after the first DMT was 3.75 years, and was not different according to the mode of administration or efficacy classification. The main reasons for changing DMT were MS activity (relapses, 56.7%; MRI activity, 18.6%), followed by non-serious adverse events (15.3%) and disability (11.1%). Younger age at MS onset, care under our centre and insurer status were the main determinants of treatment change. Network analysis showed that interferons and fingolimod were the most influential DMTs. Conclusions A majority of patients switch medications, mostly due to disease activity, and in association with age and insurer status.https://doi.org/10.1186/s12883-024-03594-3Multiple sclerosisDisease modifying therapyNetwork analysisTreatment adherencePersistence on treatmentTreatment patterns |
| spellingShingle | Simón Cárdenas-Robledo Laura Estefanía Arenas-Vargas Rubén Darío Arenas Jorge Mario Gaspar-Toro Ángela María Muñoz-Rosero Aranza Helena Tafur-Borrero Daniel Stiven Marín-Medina Hernan Andrés Acosta-Fajardo Claudia Guío-Sánchez Lorena López-Reyes Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors BMC Neurology Multiple sclerosis Disease modifying therapy Network analysis Treatment adherence Persistence on treatment Treatment patterns |
| title | Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors |
| title_full | Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors |
| title_fullStr | Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors |
| title_full_unstemmed | Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors |
| title_short | Treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors |
| title_sort | treatment patterns and persistence on disease modifying therapies for multiple sclerosis and its associated factors |
| topic | Multiple sclerosis Disease modifying therapy Network analysis Treatment adherence Persistence on treatment Treatment patterns |
| url | https://doi.org/10.1186/s12883-024-03594-3 |
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