A Retrospective Claims Analysis on Rates of Compliance and Discontinuation Among Canadian Multiple Sclerosis Patients Treated with Disease-Modifying Therapies at 6, 12 and 24-Month Periods

OBJECTIVES: To assess compliance and discontinuation rates with DMTs in Canadian patients with RRMS. METHODS: In this Canadian retrospective claims analysis based on Rx Dynamics® data from IMS Health Canada Inc., compliance and discontinuation rates were collected at 6,12 and 24-month (cohorts from 2013-2017, rolling 36 months total). Patients had >1 prescription filled for each DMT (oral: fingolimod, dimethyl fumarate (DMF), teriflunomide; injectable (BRACE): interferon beta-la, interferon beta-lb, glatiramer acetate; infusible: natalizumab). A medication possession ratio (MPR) of >80% was used to reflect patient compliance to their treatment. Discontinuation rates were calculated based on patients who stopped therapy (60 day window) or who were switched to another DMT. RESULTS: Compliance and discontinuation data was collected after 6 month (n=12543, n=9460 respectively), 12 month (n=7665, n=7234) and 24 month (n=6047, n=6030) periods. The percentage of patients deemed compliant after 6,12- and 24-months across Canada was higher for fingolimod (75%, 76%, 71% respectively), compared to natalizumab (72%, 73%, 56%), DMF (71%, 68%, 55%), and BRACE (52%, 46%, 35%) and comparable to teriflunomide (76%, 77%, 68%). Patients on fingolimod had the lowest discontinuation rate after 6,12 and 24-month periods (26%, 25%, 29% respectively) compared to: BRACE (48%, 35%, and 55%); natalizumab (34%, 29%, and 49%) and DMF (31%, 30% and 43%); and similar to teriflunomide (26%, 25%, 31%). CONCLUSIONS: The compliance for patients treated with fingolimod remained stable at all time point and was higher than for other DMTs but was comparable to teriflunomide. Unlike other DMTs, the discontinuation rate with fingolimod did not significantly increase over the 24-month period and remained lower than other DMTs and similar to teriflunomide.These findings may inform MS management strategies in Canada which may lead to improved clinical and economic outcomes.