Speaking as a clinician who goes by the mantra ‘treat early, treat hard’, platform therapies as a whole receive less attention from me than highly-active treatments. However, I know that they have a place in the MS armamentarium and admittedly, I have a more than few patients on Teriflunomide. Some of whom have been stable on it for many years, whilst others I’ve had to transfer to another DMT within a few months of commencement. The same can be said for dimethyl fumarate (or DMF). I’m also cognisant of the fact that research that non-adherence is the biggest contributor to treatment failure in MS. For example, adherence to DMTs in MS varies between 41-93%, whilst by comparison the adherence rates in diabetics taking insulin for Type 2 SM varies between 62-64%. So it is important to get the treatment right from the start.
If we take a look at teriflunomide it has roughly 30% annual relapse rate reduction, it is an oral tablet taken once a day, and it’s side effects to consider before starting treatment is hair thinning and frequent blood tests for liver function monitoring. The long-term safety analysis (9 years follow up) suggests that it is largely well tolerated (see Figure below).
In a new questionnaire based observational study from Australia, investigators studied treatment satisfaction with teriflunomide at 24 and 48 weeks.
In roughly, more than a half of the patients surveyed, teriflunomide was their first MS DMT. The average treatment satisfaction was >60% (see Figure below).
Convenience in particular seems to be in favour of teriflunomide. Treatment satisfaction was also found to be correlated with the number of missed tablet doses; with a decrease in satisfaction as the number of missed doses increased.
It is important to realise the setting of this study. In Australia for relapsing-remitting MS (RRMS) there are 14 licensed therapies: five injectables (glatiramer acetate, interferon beta-1a, interferon beta-1b, peg interferon beta-1a, ofatumumab), six oral (cladribine, dimethyl fumarate, fingolimod, ozanimod, siponimod, teriflunomide) and three administered via infusion (alemtuzumab, natalizumab, ocrelizumab). There is no pre-mandated hierarchy to their DMTs or a guidance as to which therapies are prescribed first or to follow on from beyond what is stated on the label (i.e. the drugs licensed indication). Therefore, pretty much you have your pick of treatments. In situations such as these, satisfaction with treatments plays a huge role.
Treatment satisfaction in patients with relapsing-remitting multiple sclerosis initiated on teriflunomide in routine clinical practice: Australian observational data
Todd A Hardy , John Parratt , Heidi Beadnall , Stefan Blum , Richard Macdonell , Roy G Beran , Neil Shuey, Andrew Lee , William Carroll , Cameron Shaw , Richard Worrell , Jana Moody , Mamdouh Sedhom , Michael Barnett, Steve Vucic
Background: Adherence and persistence are critical to optimising therapeutic benefit from disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS). This prospective, open-label, multicentre, observational study (AubPRO), conducted in 13 hospital-based neurology clinics around Australia, describes treatment satisfaction in patients newly initiated on teriflunomide (Aubagio) and evaluates the use of an electronic patient-reported outcome (PRO) tool.
Methods: Patients (≥18 years) newly initiated on teriflunomide (14 mg/day) were followed up at 24 and 48 weeks. Patients completed questionnaires and pill counts electronically using MObile Data in Multiple Sclerosis. The primary endpoint was treatment satisfaction, measured by the Treatment Satisfaction Questionnaire for Medication (TSQM, V.1.4), at week 48. Secondary endpoints included treatment satisfaction at week 24, other PRO scales, clinical outcomes, medication adherence and safety.
Results: Patients (n=103; 54 (52.4%) treatment naive) were mostly female (n=82 (79.6%)), aged 49.5 (11.8) years, with MS duration since symptom onset of 9.1 (11.8) years and a median Expanded Disability Status Scale score of 1.0. Mean treatment satisfaction scores were high (≥60%) across all domains of the TSQM V.1.4 at week 24 and at week 48. Compared with week 24, week 48 treatment satisfaction increased for patients who were treatment naïve and for those previously on another oral or injectable DMT. Over 48 weeks, PROs remained stable across a range of measures including disability, physical health, emotional health and mobility, and there were improvements in work capacity and daily life activity. Adherence was high throughout the study with mean compliance (pill counts) of 93.2%±6.26%, and 98 of 103 (95.1%) patients remained relapse-free.
Conclusion: This cohort of Australian patients with RRMS, newly initiated on teriflunomide, and treated in a real-world clinical practice setting, reported high treatment satisfaction and adherence at 24 and 48 weeks. Patient-reported measures of disability remained stably low, work capacity and daily life activity improved, and most patients remained relapse-free.