Why the disease modifying therapy transition? Investigating the reasons and clinical consequences in multiple...

More than twenty brand name and generic disease modifying therapy (DMT) formulations are approved by the U.S. Food and Drug Administration for use in multiple sclerosis (MS). We aimed to understand the reasons for DMT transitions, examine transition patterns across different demographics, and determine if clinical and radiological consequences were associated with transitions.

Retrospective study of medical records was performed within a single MS specialty clinic, including individuals with relapsing-remitting MS from January 2010 to October 2022 with at least one DMT transition. Cohorts of Non-European ancestry (Non-EA) and European ancestry (EA) individuals were created. The reasons for transition, differences in rate of transitions, and associations with social determinants of health (SDoH) were assessed between cohorts. The effects of medication transitions on MRI activity, acute relapse/hospitalization occurrence, physician-reported and patient-reported disease worsening, and timing of next treatment were also assessed.

A total of 1134 individuals comprised of 78.4 % females with a mean age (SD) of 33.6 years (11.1 years) were analyzed. After adjusting for SDoH, the data do not suggest a difference in DMT transition time between EA and Non-EA groups (HR=1.11, CI=[1.00, 1.24]). Individuals citing non-medical reasons were 55 % less likely to immediately initiate the next DMT than those reporting medical reasons (CI=[0.30, 0.67]). For each additional medical-related transition, the odds of physician-reported and patient-reported disease worsening increased by 4.69-fold (CI=[3.50, 6.41]) and 4.48-fold (CI=[3.35, 6.14]), respectively.

DMT transitions are prevalent and understanding the reasons for transitions may improve disease management and timely initiation of subsequent treatment.