Exit strategies for "needle fatigue" in multiple sclerosis: a propensity score-matched comparison study

Area of Science:

• Neurology
• Pharmacology
• Treatment Adherence

Background:

• Long-term injectable therapies for multiple sclerosis (MS) can lead to "needle fatigue," reducing patient adherence.
• Alternative treatment strategies are needed to improve persistence in MS patients on injectable medications.

Purpose of the Study:

• To compare treatment persistence and time to first relapse in stable MS patients switching from injectables to oral dimethyl fumarate (DMF), teriflunomide (TFN), or pegylated interferon (PEG).

Main Methods:

• An independent, multicentre, post-marketing study analyzed 621 stable MS patients switching to DMF (n=265), TFN (n=160), or PEG (n=196).
• Cox regression models and propensity score (PS)-based matching were used to analyze time to discontinuation and time to first relapse over 12 months.

Main Results:

• Treatment discontinuation was significantly higher for PEG (28.6%) compared to DMF (14.7%) and TFN (16.9%).
• Higher PEG discontinuation was linked to poor tolerability and pregnancy planning.
• Relapse rates were low (4%), precluding short-term relapse risk analysis.

Conclusions:

• Oral therapies (DMF, TFN) are superior to low-frequency interferon (PEG) for improving short-term treatment persistence in stable MS patients switching from injectables.
• Switching to oral medications is a viable strategy for patients experiencing "needle fatigue" or tolerability issues with injectable MS treatments.