Canadian study looks at use of injectable MS meds
A new study reports that most people taking an injectable medication for their MS stop taking it within four years, although many go back to the regimen later on (Melesse and colleagues. Patient Prefer Adherence 2017;11:1093-11010).
The study used information for the period 1996-2011 from a public health database of 721 people with MS from the Canadian province of Manitoba. The average age of study subjects when they started an MS medication was 37-38 years. The median time from receiving an MS diagnosis to starting a treatment was 8-9 months. One-third of people started treatment with Betaseron (the first MS medication to become available in the province), 23% started with Rebif or Avonex, and 21% started with Copaxone. (The time period of the analysis was before oral therapies were available.)
Overall, 63% of people stopped their initial treatment during the course of the study, with 50% stopping within the first two years. The median time to stopping an injectable medication was 4 years. About 58% of people who quit eventually started another injectable medication (with many trying a couple of different injectables). Some of these stop/re-starts were likely to have been treatment interruptions due to medical reasons, such as side effects or pregnancy. About one-third of people overall did not re-start an injectable, but the study didn’t report on whether they started on a a different type of MS drug (Tysabri or Gilenya), or whether they quit treatment altogether.
Younger people were more likely to stop than older people. This may be because older people had more severe disease, although other studies of various medical conditions have also found that older people are generally better at taking medications than younger people.
People who started treatment before the year 2000 were more likely to stay with injectable treatment compared to those diagnosed in later periods. This is likely due to treatment choice: as more medications became available (Tysabri in 2006, Gilenya in 2010), people may have opted for (or needed) a more potent or convenient therapy. In this regard, switching off injectables has likely become more common with the new treatment options introduced in the past five years (Aubagio, Tecfidera, Lemtrada, Zinbryta).
An alternative explanation for more frequent discontinuations after the year 2000 is that people diagnosed more recently may have perceived their MS to be less severe; if they were less severely affected, they may have felt that they weren’t benefiting from treatment.
An important factor influencing whether people stayed with treatment was how long it took for them to start treatment – a longer delay from diagnosis to treatment meant a greater likelihood of stopping the drug. The researchers suggested that this may be because people who started treatment sooner may have had more severe disease – so MS represented more of an immediate threat to their health. Conversely, a longer delay to starting a medication may have meant that people were less convinced about the need for treatment, so they were more likely to quit later on. It may also be that if a doctor didn’t raise any strong concerns about delaying treatment for a year or two, people may have interpreted this as a sign that their MS wasn’t severe, or that treating it wasn’t all that important.
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