Real-world persistence of multiple sclerosis disease-modifying therapies

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Treatment persistence is crucial for managing multiple sclerosis (MS), reflecting therapy efficacy and tolerability.
• Understanding real-world persistence and discontinuation reasons for disease-modifying therapies (DMTs) is vital for optimizing patient care.

Purpose of the Study:

• To determine real-world persistence rates of DMTs in people with MS (pwMS).
• To identify primary reasons for DMT discontinuation in pwMS.
• To compare persistence across different classes of MS DMTs.

Main Methods:

• Retrospective analysis of treatment data from 4366 pwMS across 13 UK centers (2021).
• Inclusion criteria: exposure to at least one MS DMT with a complete prescription history.
• Kaplan-Meier survival analysis used to assess DMT persistence; discontinuation defined by starting a new DMT for immune reconstituting therapies.

Main Results:

• Median time on a single maintenance DMT was 4.3 years.
• Most common discontinuation reasons: adverse events (35.0%) and lack of efficacy (30.3%).
• After 10 years, only 20% on alemtuzumab switched DMTs, versus 82% on interferon or glatiramer acetate.

Conclusions:

• Immune-reconstituting DMTs demonstrate potential for sustained treatment in relapsing MS.
• Comparative DMT persistence data aids in informed treatment decisions and personalized MS management.