Although more than a dozen disease-modifying treatments (DMTs) are available for relapsing forms of multiple sclerosis (MS), treatment interruptions, switches, and discontinuations are common challenges. This study focuses on describing treatment interruptions and discontinuations within the Big Multiple Sclerosis Data Network. Under the leadership of Prof. Jan Hillert from Sweden's Karolinska Institutet, data from five clinical registries covering a 20-year period were merged in this cohort study. The results provide an overview of trends in treatment discontinuation and interruption among MS patients and the factors leading to these changes. Data from some Czech MS centers are represented in this study through the international research database MSBase.
Hillert, J., Magyari, M., Soelberg Sørensen, P., Butzkueven, H., Van Der Welt, A., Vukusic, S., Trojano, M., Iaffaldano, P., Pellegrini, F., Hyde, R., Stawiarz, L., Manouchehrinia, A., & Spelman, T. (2021). Treatment Switching and Discontinuation Over 20 Years in the Big Multiple Sclerosis Data Network. In Frontiers in Neurology (Vol. 12). Frontiers Media SA. https://doi.org/10.3389/fneur.2021.647811 PMID: 33815259
Abstract
Background: Although over a dozen disease modifying treatments (DMTs) are available for relapsing forms of multiple sclerosis (MS), treatment interruption, switching and discontinuation are common challenges. The objective of this study was to describe treatment interruption and discontinuation in the Big MS data network.
Methods: We merged information on 269,822 treatment episodes in 110,326 patients from 1997 to 2016 from five clinical registries in this cohort study. Treatment stop was defined as a clinician recorded DMT end for any reason and included treatment interruptions, switching to alternate DMTs and long-term or permanent discontinuations.
Results: The incidence of DMT stopping cross the full observation period was lowest in FTY (19.7 per 100 person-years (PY) of treatment; 95% CI 19.2-20.1), followed by NAT (22.6/100 PY; 95% CI 22.2-23.0), IFNβ (23.3/100 PY; 95% CI 23.2-23.5). Of the 184,013 observed DMT stops, 159,309 (86.6%) switched to an alternate DMT within 6 months. Reasons for stopping a drug were stable during the observation period with lack of efficacy being the most common reason followed by lack of tolerance and side effects. The proportion of patients continuing on most DMTs were similarly stable until 2014 and 2015 when drop from 83 to 75% was noted.
Conclusions: DMT stopping reasons and rates were mostly stable over time with a slight increase in recent years, with the availability of more DMTs. The overall results suggest that discontinuation of MS DMTs is mostly due to DMT properties and to a lesser extent to risk management and a competitive market.
Entire paper is available in English on the website of the Frontiers in Neurology.
