Treatment Patterns and Risk of Comorbidity Among Newly Diagnosed Patients With MS

Treatment-naïve patients with multiple sclerosis (MS) have greater reductions in MS relapses with initiation of oral disease-modifying therapies (DMTs) compared with injectable DMT,¹ according to an abstract presented at ECTRIMS 2019, the 35th Annual Congress of the European Committee for Treatment and Research in Multiple Sclerosis.

The researchers described treatment patterns and relapses among patients with MS who were being newly treated by treatment. They used IBM MarketScan research databases to identify patients with MS who had not taken DMTs in the 12 months prior initiating DMTs (index event).

They included a total of 9378 patients, with an average age of 46.7 years. The cohort was 73.3% female. The overall nonpersistence and nonadherence rates were 39.1% and 44.7%, respectively. The majority (65.5%) started with an injectable DMT, followed by oral DMT (26.1%), and infusion DMT (8.5%).

One-third of patients relapsed preindex and one-fourth relapsed postindex. Patients who started on oral DMTs had a 39% reduction in relapses postindex compared with patients who started on injectable DMTs, who had a 22% reduction.

Patients who relapsed within 3 months and 6 months of initiation had low 12-month persistency (49.0% and 48.4%, respectively). Patients on oral agents had the highest 12-month persistence (50.3%) among those who relapsed 3 months or sooner after initiating treatment.

Meanwhile, a nationwide study in Sweden showed that patients with MS display an increased rate of comorbidities before their diagnosis compared with patients who don’t have MS, according to another abstract.²

The researchers used a national cohort of patients diagnosed with MS from 2008 to 2016 in the Swedish National Patient Register, plus a subcohort of patients with MS identified from the electronic medical records of the Karolinska University Hospital.

Patients with MS were matched to 10 individuals who did not have MS by age, sex, and region of residence. A total of 6602 patients with MS were compared with 61,828 controls and in the subcohort, 1289 patients with MS were compared with 11,721 patients without MS. The patients in the subcohort were slightly younger than the nationwide cohort (median age, 37 years vs 40 years).

The national cohort had higher proportions of most comorbidities before being diagnosed with MS compared with the control group: autoimmune disease (1.3% vs 0.7%), bladder dysfunction (1.2% vs 0.2%), retinal disorders (2.4% vs 1.2%), and epilepsy (1.5% vs 0.8%). After diagnosis of MS, patients continued to have higher incidence rates (IR) per 10,000 person-years than controls.

Some differences between the national cohort and the subcohort was that bipolar disorder was more common among the subcohort before diagnosis of MS and IR of bipolar disorder was higher after diagnosis. IR of toxic liver disease was higher only in the national cohort after diagnosis.

“Before a diagnosis of MS, patients already displayed an increased rate of comorbidity compared with MS-free controls,” the authors concluded. “After diagnosis, patients with MS continued to display increased risk of several comorbidities, some of which may be explained by surveillance bias due to more frequent contact with healthcare.”

References

1. Kantor D, Mehta R, Pelletier C, et al. Treatment patterns among treatment-naïve multiple sclerosis patients in a commercially insured US population. Presented at: ECTRIMS 2019, Stockholm, Sweden; September 11-13, 2019. Poster P1065.

2. Piehl F, Castelo-Branco A, Chiesa F, et al. Risk of comorbidity in patients with multiple sclerosis: a nationwide cohort study in Sweden. Presented at: ECTRIMS 2019, Stockholm, Sweden; September 11-13, 2019. Poster 272.