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DIscontinuation of disease-modifying therapies in older adults with multiple sclerosis
Jieni Li1, George J Hutton2, Rajender R Aparasu1
1Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, TX, USA; Population Health Outcomes and Pharmacoepidemiology Education and Research Center (P-HOPER Center), University of Houston College of Pharmacy, Houston, TX, USA.
Background:
Disease-modifying therapy (DMT) use in older adults with multiple sclerosis (MS) is debated due to age-related factors, effectiveness, and economic concerns of DMTs. Therefore, this study examined the factors influencing the discontinuation of DMTs in older adults with MS.
Methods:
This retrospective cohort study included Medicare beneficiaries (≥66 years) with MS who are persistent DMT users. Discontinuation of DMT was defined as ≥12 consecutive months without DMT use, while continuation of DMT was defined as maintaining Proportion of Days Covered ≥80% for an additional 24 months. A multivariable logistic regression was used to identify the baseline factors associated with DMT discontinuation.
Results:
Among 8,694 eligible aged Medicare beneficiaries with persistent DMT use, 1,025 (11.79%) discontinued DMTs. The discontinuation cohort had a mean age of 69.7 ± 3.9 years, with 79.5% females and 91.1% Whites. Older age, recent years, and clinical complexity, such as frailty and disability, were associated with lower odds of discontinuation. However, patients with dual eligibility and certain comorbidities were more likely to discontinue therapy.
Conclusions:
Among older MS patients with persistent DMT use, about 12% discontinued, with significant sociodemographic and clinical characteristics influencing DMT discontinuation. Evaluation of the outcomes of DMT discontinuation is warranted to inform treatment decisions and enhance geriatric MS care.
Insights
About 12% of older adults with multiple sclerosis (MS) stopped disease-modifying therapy (DMT). Factors like age, frailty, and disability influenced this decision, highlighting the need for tailored geriatric MS care.
Area of Science:
- Geriatric Medicine
- Neurology
- Pharmacoeconomics
Background:
- Disease-modifying therapy (DMT) use in older adults with multiple sclerosis (MS) is debated.
- Age-related factors, effectiveness, and cost influence DMT decisions in this population.
Purpose of the Study:
- To examine factors influencing DMT discontinuation in older adults with MS.
- To identify sociodemographic and clinical predictors of DMT cessation in this demographic.
Main Methods:
- Retrospective cohort study of Medicare beneficiaries (≥66 years) with MS and persistent DMT use.
- DMT discontinuation defined as ≥12 months without use.
- Multivariable logistic regression analyzed baseline factors associated with discontinuation.
Main Results:
- 11.79% of 8,694 eligible individuals discontinued DMTs.
- Older age, frailty, and disability were linked to lower discontinuation odds.
- Dual eligibility and certain comorbidities increased the likelihood of discontinuing therapy.
Conclusions:
- Significant sociodemographic and clinical factors influence DMT discontinuation in older MS patients.
- Approximately 12% of older MS patients with persistent DMT use discontinued therapy.
- Further evaluation of DMT discontinuation outcomes is crucial for geriatric MS care.
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