Although more than a dozen disease-modifying therapies (DMTs) are available for relapsing forms of multiple sclerosis (MS), interruptions, changes, and discontinuations are common challenges. This study focuses on describing treatment interruptions and discontinuations in a group of Big Multiple Sclerosis Data Network registries. This cohort study was led by the Prof. Jan Hillert from Karolinska Institutet, Sweden, merged data from five clinical registries covering a 20-year period. The results provide an overview of the trends in treatment discontinuation and interruption in MS patients and the factors that lead to these changes. Data from several Czech MS centres 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
Introduction: Although more than a dozen disease-modifying therapies (DMTs) are available for relapsing forms of multiple sclerosis (MS), treatment interruptions, treatment changes, and treatment discontinuation are common challenges. The aim of this study was to describe treatment discontinuation and cessation in a group of Big Multiple Sclerosis Data Network registries.
Methods: In this cohort study, we pooled information on 269 822 treatment episodes in 110 326 patients from five clinical registries between 1997 and 2016. Treatment termination was defined as clinician-recorded end of DMT for any reason, including discontinuation, switching to another DMT, and long-term or permanent cessation of treatment.
Results: The incidence of DMT discontinuation during the entire observation period was lowest for FTY (19.7 per 100 person-years of treatment; 95% CI 19.2-20.1), followed by NAT (22.6/100 person-years; 95% CI 22.2-23.0) and IFNβ (23.3/100 person-years; 95% CI 23.2-23.5). Of the 184,013 DMT discontinuations recorded, 159,309 (86.6 %) switched to another DMT within 6 months. Reasons for discontinuation remained stable during the observation period, with the most common reason being lack of efficacy, followed by lack of tolerance and side effects. The proportion of patients continuing treatment on most DMTs remained stable until 2014 and 2015, when there was a decrease from 83 % to 75 %.
Conclusions: Reasons for and rates of DMT discontinuation have been mostly stable over time, with a slight increase in recent years, with the availability of more DMTs. Overall results suggest that DMT discontinuation is mostly driven by DMT characteristics and to a lesser extent by risk management and market competition.
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