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Why the disease modifying therapy transition? Investigating the reasons and clinical consequences in multiple
Darin T Okuda1, Tom G Punnen1, Tatum M Moog1
1The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, TX, USA.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
DMT transitions are prevalent and understanding the reasons for transitions may improve disease management and timely initiation of subsequent treatment.
Insights
Understanding reasons for disease-modifying therapy (DMT) transitions in multiple sclerosis (MS) is key. Medical reasons for DMT changes increase disease worsening, impacting management and treatment initiation.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Over twenty disease-modifying therapy (DMT) formulations exist for multiple sclerosis (MS).
- Understanding reasons for DMT transitions is crucial for effective MS management.
- Investigating demographic patterns and clinical consequences of DMT transitions is needed.
Purpose of the Study:
- To investigate the reasons for DMT transitions in multiple sclerosis (MS).
- To examine DMT transition patterns across European ancestry (EA) and Non-European ancestry (Non-EA) demographics.
- To determine the clinical and radiological consequences associated with DMT transitions.
Main Methods:
- Retrospective study of medical records from an MS specialty clinic (2010-2022).
- Analysis of relapsing-remitting MS patients with at least one DMT transition.
- Comparison of EA and Non-EA cohorts, assessing reasons for transition, SDoH, and clinical outcomes.
Main Results:
- No significant difference in DMT transition time between EA and Non-EA groups after adjusting for SDoH.
- Non-medical reasons for transition were associated with a 55% lower likelihood of immediate next DMT initiation.
- Each medical-related DMT transition increased the odds of physician-reported and patient-reported disease worsening significantly.
Conclusions:
- Disease-modifying therapy (DMT) transitions are common in multiple sclerosis (MS) care.
- Identifying reasons for DMT transitions can optimize disease management.
- Timely initiation of subsequent treatments following transitions is essential for better patient outcomes.
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