Switching to Fingolimod

Warrender-Sparkes M, Spelman T, Izquierdo G, Trojano M, Lugaresi A, Grand’Maison F, Havrdova E, Horakova D, Boz C, Oreja-Guevara C, Alroughani R, Iuliano G, Duquette P, Girard M, Terzi M, Hupperts R, Grammond P, Petersen T, Fernandez-Bolaños R, Fiol M, Pucci E, Lechner-Scott J, Verheul F, Cristiano E, Van Pesch V, Petkovska-Boskova T, Moore F, Kister I, Bergamaschi R, Saladino ML, Slee M, Barnett M, Amato MP, Shaw C, Shuey N, Young C, Gray O, Kappos L, Butzkueven H, Kalincik T, Jokubaitis V; MSBase study group The effect of oral immunomodulatory therapy on treatment uptake and persistence in multiple sclerosis. Mult Scler. 2015. pii: 1352458515594041. [Epub ahead of print]

OBJECTIVE:We aimed to analyse the effect of the introduction of fingolimod, the first oral disease-modifying therapy, on treatment utilisation and persistence in an international cohort of patients with multiple sclerosis (MS).
METHODS:MSBASIS, a prospective, observational sub-study of the MSBase registry, collects demographic, clinical and paraclinical data on patients followed from MS onset (n=4718). We conducted a multivariable conditional risk set survival analysis to identify predictors of treatment discontinuation, and to assess if the introduction of fingolimod has altered treatment persistence.
RESULTS:A total of 2640 patients commenced immunomodulatory therapy. Following the introduction of fingolimod, patients were more likely to discontinue all other treatments (hazard ratio 1.64, p<0.001) while more patients switched to fingolimod than any other therapy (42.3% of switches). Patients switched to fingolimod due to convenience. Patients treated with fingolimod were less likely to discontinue treatment compared with other therapies (p<0.001). Female sex, country of residence, younger age, a high Expanded Disability Status Scale score and relapse activity were all independently associated with higher rates of treatment discontinuation.
CONCLUSION: Following the availability of fingolimod, patients were more likely to discontinue injectable treatments. Those who switched to fingolimod were more likely to do so for convenience. Persistence was improved on fingolimod compared to other medication.

People switch from low efficacy injectable drugs that have limited effect on atrophy to a treatment that is more convenient, and more efficacious.  Is there any surprise.

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  • I think it will be interesting over the next few years as the post marketing studies etc start to reveal the real side effects load that the newer drugs have. It remains to be seen whether the switching to oral agents stays as high – as has been stated on this blog quite a few times – higher efficacy often equals more side effects, some of which can be far more damaging or even fatal. Only time will tell……..

  • How fast are your tapping feet? Can your neurologist keep up with all the medication changes or should patients attend a one stop shop. In the UK currently published figures are one neurologist per 90,000 – are we being realistic about what services we can safely offer?

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