Patients with multiple sclerosis on long-term injectable therapies may suffer from the so-called "needle fatigue", i.e., a waning commitment to continue with the prescribed injectable treatment. Therefore, alternative treatment strategies to enhance patients' adherence are warranted. In this independent, multicentre post-marketing study, we sought to directly compare switching to either teriflunomide (TFN), dimethyl fumarate (DMF), or pegylated interferon (PEG) on treatment persistence and time to first relapse over a 12-month follow-up. We analyzed a total of 621 patients who were free of relapses and gadolinium-enhancing lesions in the year prior to switching to DMF (n = 265), TFN (n = 160), or PEG (n = 196). Time to discontinuation and time to first relapse were explored in the whole population by Cox regression models adjusted for baseline variables and after a 1:1:1 ratio propensity score (PS)-based matching procedure. Treatment discontinuation was more frequent after switching to PEG (28.6%) than DMF (14.7%; hazard ratio [HR] = 0.25, p < 0.001) and TFN (16.9%; HR = 0.27, p < 0.001). We found similar results even in the re-sampled cohort of 222 patients (74 per group) derived by the PS-based matching procedure. The highest discontinuation rate observed in PEG recipient was mainly due to poor tolerability (p = 0.005) and pregnancy planning (p = 0.04). The low number of patients who relapsed over the 12-month follow-up (25 out of 621, approximately 4%) prevented any analysis on the short-term risk of relapse. This real-world study suggests that oral drugs are a better switching option than low-frequency interferon for promoting the short-term treatment persistence in stable patients who do not tolerate injectable drugs.

Exit strategies for "needle fatigue" in multiple sclerosis: a propensity score-matched comparison study / Prosperini, Luca; Cortese, Antonio; Lucchini, Matteo; Boffa, Laura; Borriello, Giovanna; Buscarinu, Maria Chiara; Capone, Fioravante; Centonze, Diego; De Fino, Chiara; De Pascalis, Daniela; Fantozzi, Roberta; Ferraro, Elisabetta; Filippi, Maria; Galgani, Simonetta; Gasperini, Claudio; Haggiag, Shalom; Landi, Doriana; Marfia, Girolama; Mataluni, Giorgia; Millefiorini, Enrico; Mirabella, Massimiliano; Monteleone, Fabrizia; Nociti, Viviana; Pontecorvo, Simona; Romano, Silvia; Ruggieri, Serena; Salvetti, Marco; Tortorella, Carla; Zannino, Silvana; Di Battista, Giancarlo. - In: JOURNAL OF NEUROLOGY. - ISSN 0340-5354. - (2019). [10.1007/s00415-019-09625-1]

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

Prosperini, Luca;Cortese, Antonio;Borriello, Giovanna;Buscarinu, Maria Chiara;Gasperini, Claudio;Haggiag, Shalom;Millefiorini, Enrico;Pontecorvo, Simona;Romano, Silvia;Ruggieri, Serena;Salvetti, Marco;
2019

Abstract

Patients with multiple sclerosis on long-term injectable therapies may suffer from the so-called "needle fatigue", i.e., a waning commitment to continue with the prescribed injectable treatment. Therefore, alternative treatment strategies to enhance patients' adherence are warranted. In this independent, multicentre post-marketing study, we sought to directly compare switching to either teriflunomide (TFN), dimethyl fumarate (DMF), or pegylated interferon (PEG) on treatment persistence and time to first relapse over a 12-month follow-up. We analyzed a total of 621 patients who were free of relapses and gadolinium-enhancing lesions in the year prior to switching to DMF (n = 265), TFN (n = 160), or PEG (n = 196). Time to discontinuation and time to first relapse were explored in the whole population by Cox regression models adjusted for baseline variables and after a 1:1:1 ratio propensity score (PS)-based matching procedure. Treatment discontinuation was more frequent after switching to PEG (28.6%) than DMF (14.7%; hazard ratio [HR] = 0.25, p < 0.001) and TFN (16.9%; HR = 0.27, p < 0.001). We found similar results even in the re-sampled cohort of 222 patients (74 per group) derived by the PS-based matching procedure. The highest discontinuation rate observed in PEG recipient was mainly due to poor tolerability (p = 0.005) and pregnancy planning (p = 0.04). The low number of patients who relapsed over the 12-month follow-up (25 out of 621, approximately 4%) prevented any analysis on the short-term risk of relapse. This real-world study suggests that oral drugs are a better switching option than low-frequency interferon for promoting the short-term treatment persistence in stable patients who do not tolerate injectable drugs.
File allegati a questo prodotto
File Dimensione Formato  
Prosperini_Exit strategies for “needle fatigue”_2019.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 1.01 MB
Formato Adobe PDF
1.01 MB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1330837
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 4
  • ???jsp.display-item.citation.isi??? 0
social impact