As scientists, clinicians, people in general, we are content to follow sentiments from the latest book, TED talks and media in general with the customary hyperbole that willingly spurn concepts that don’t suit our purpose, thereby swelling view points to the metaphorical ranks of truly regal proportions in our minds. In short, this is what conferences are about; if you discount the initial annoyances of Passport control and the Department For Transport (DaFT).
But the poster halls are taken up by the aspiring new (not yet jaded), pharma regalia and beverages (reminiscent of punch served at a debutante ball). I have selected a few of these below and will let you decide whether they meet your standards (keyword – real life experience).
(DX35) Relapse rates of patients with multiple sclerosis newly initiating subcutaneous Interferon Beta-1a versus oral disease-modifying drugs in the real world.
C Kozma, F Munschauer, A Phillips (supported by EMD Serono, manufacturers of Avonex IFN B1a)
Background: Administrative claims data provide information on outcomes in actual clinical care settings in a broader patient population (patients from IMS Lifelink PharMetric Plus database between 1/1/2012 and 6/30/2013).
Results: 1665 patients (686 scIFNB1a, 118 teriflunomide, 455 fingolimod, and 406 dimethyl fumarate) met inclusion criteria (mean age = 44.4 years; 75.5% female). Unadjusted analyses showed that MS-related hospitalizations and ER visits did not differ among DMDs; however, the proportion of patients with an MS-related outpatient relapse was lower in patients initiating scIFNB1a (19.7%) vs. teriflunomide (32.2%; P=0.003) and dimethyl fumarate (26.8%; P=0.039). Proportion of patients with >/= 1 MS relapse of any type was lower with scIFN1Ba vs. oral DMDs (21.7% and 26.1%, respectively, P=0.039). Logistic regression controlling for demographic and 90-day pre-index indicators showed that initiation of teriflunomide or dimethyl fumarate were associated with higher likelihood of relapse (odds ratio [OR] = 2.1; P=0.001 and OR = 1.5; P = 0.005, respectively) vs. scIFNB1a.
Conclusions: In this real-world population, after controlling for demographics and pre-index clinically meaningful indicators of disease severity, patients initiating scIFNb1a had a lower likelihood of experiencing surrogates for relapse in the first year than initiating teriflunomide or dimethyl fumarate.
(DX47) Key results from PREFERMS: Real-world patient retention and outcomes on Fingolimod versus platform injectable disease-modifying therapies in early relapsing-remitting multiple sclerosis
M Cascione, B AC Cree, D Wynn, X Meng, L Schofield, N Tenenbaum, on behalf of PREFERMS Investigators (supported by Novartis, manufacturers of Fingolimod)
Background: Suboptimal adherence to injectable disease-modifying therapy (iDMT) classes is well established. PREFERMS is the first large study of treatment retention with DMTs and other outcomes in patients with relapsing-remitting multiple sclerosis (RRMS). (PREFERMS was a 12-month, phase 4, open-label, active-controlled, randomized, multicenter study).
Results: 875 patients were randomized (fingolimod, n=436; iDMT, n=439). At baseline, mean time since diagnosis was 4.3 years and Expanded Disability Status Scale score was 2.4. In the full analysis set (n = 861), 352 (81.3%) patients on fingolimod and 125 (29.2%) on iDMT completed randomized treatment (P<0.01). Despite the shorter duration of exposure to iDMTs, the annualized relapse rate was numerically lower with fingolimod (ratio, 0.7; P=0.084). There was less brain volume loss (change from baseline at month 6, 0.19% vs. 0.31%, P=0.011); month 12, 0.40% vs. 0.56%, P=0.076), less cortical gray matter loss (change from baseline at last assessment 0.09% vs 0.29%; P=0.002), and treatment satisfaction was greater (medication satisfaction questionnaire: P<0.001, all assessments).
Conclusions: Higher therapeutic retention, improved clinical and radiographic outcomes, greater treatment satisfaction, and tolerability support fromt-line use of fingolimod over platform iDMTs in patients with early RRMS.
(DX51) Real-world comparison of relapse rates in multiple sclerosis patients treated with disease-modifying therapies
A Boster, J Nicholas, N Wu, W-S Yeh, M A Fay, M R Edwards, M-Y Huang, A Lee (Supported by Biogen, manufacturers of DMF)
Background: The effectiveness of disease-modifying therapies (DMTs) for multiple sclerosis (MS) has not been comprehensively studied in a real-world setting (this study used MarketScan, a large US commercial insurance database).
Results: A total of 3352 DMF (Dimethyl Fumarate), 1057 GS (Glatiramer Acetate), 884 IFN (Interferon), 579 FTY (Fingolimod), and 500 TER (Teriflunomide) were included in the analysis. Baseline differences were seen in age (46.7, 43.5, 43.6, 43.8, and 49.6, respectively; P<0.01), proportion of females (76.6%, 79%, 78.6%, 76.2% vs. 80%, respectively; P=0.21), proportion with other DMT in the prior year (68.7%, 15.7%, 13.5%, 64.2%, and 66%, respectively; P<0.01), and ARR in the prior year (0.43, 0.31, 0.37, 0.44, and 0.38, respectively; P<-.01). Using DMF as the reference, the adjusted incidence rate ratio was 1.34 (95% confidence interval [CI]: 1.17-1.530 for GA, 1.27 (1.10-1.46) for IFN, 1.03 (0.88-1.21) for FTY, and 1.23 (1.05-1.45) for TER.
Conclusions: DMF demonstrated significantly better effectiveness than GA, IFN, and TER in the real-world setting. No significant difference was observed between DMF and FTY.