Abstract Details

Title Meta-analysis of real-world adherence and persistence of maintenance once- or twice-daily oral disease-modifying drugs (dimethyl fumarate, fingolimod, and teriflunomide) in multiple sclerosis

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-041

Objective

To conduct meta-analyses of reported rates of real-world adherence and/or persistence of once- or twice-daily oral maintenance disease-modifying drugs ([DMDs]; dimethyl fumarate, fingolimod, and teriflunomide) in patients with multiple sclerosis (MS).

Background

Medication adherence remains a challenge among patients with MS.

Design/Methods

A systematic literature review of studies published between January 2010–April 2018 evaluating adherence and/or persistence with once- or twice-daily oral DMDs was performed. Two individuals reviewed search results and article reference lists; three individuals extracted data. Quality of selected studies was evaluated using a modified version of the Newcastle-Ottawa Scale. Fixed-effects models (FEMs) or random-effects models (REMs) were evaluated for pooling summary estimates of nonadherence by the specific adherence measures.

Cochran’s Q test and the I² statistic evaluated if heterogeneity existed between estimates of

population parameter, and subgroup analysis helped discern the source of hetereogeneity. Egger’s test was used to detect publication bias.

Results

From 510 citations, 31 studies comprising 16,398 patients with MS were included. Significant Cochran’s Q and I² >50% confirmed the use of REMs. No significance for the Egger’s test suggests publication bias was not present. The overall 1-year mean medication possession ratio ([MPR]; n=4 studies) for oral DMDs was 83.3% (95% confidence interval [CI]: 74.5%–92.1%) and the overall 1-year mean proportion of days covered ([PDC]; n=4 studies) was 76.5% (95%CI: 72.0%–81.1%). The pooled MPR ≥80% adherence rate across studies (n=6) was 78.5% (95%CI: 63.5%–88.5%) and the pooled PDC ≥80% adherence rate (n=5 studies) was 71.8% (95%CI: 59.1%–81.9%). The pooled discontinuation rate across studies (n=20) for oral DMDs was 25.4% (95%CI: 21.6%-29.7%).

Conclusions

This meta-analysis of real-world studies showed that one in five patients with MS do not adhere to once- or twice-daily oral maintenance DMDs and one in four discontinue DMDs before 1 year. Opportunities to improve adherence in patients with MS remain.

Authors/Disclosures
Amy L. Phillips, PharmD (EMD Serono) PRESENTER	Amy L. Phillips, PharmD has received personal compensation for serving as an employee of EMD Serono, Inc.
Jacqueline A. Nicholas, MD (OhioHealth Riverside Methodist Hospital)	Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squib. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Greenwich Biosciences. Dr. Nicholas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Nicholas has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD Serono. Dr. Nicholas has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Genentech. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Vielo Bio. Dr. Nicholas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb. The institution of Dr. Nicholas has received research support from Novartis. The institution of Dr. Nicholas has received research support from Biogen. The institution of Dr. Nicholas has received research support from Genentech. The institution of Dr. Nicholas has received research support from PCORI. Dr. Nicholas has a non-compensated relationship as a Physician with National MS Society that is relevant to AAN interests or activities. Dr. Nicholas has a non-compensated relationship as a Physician with Siegal Rare Neuroimmune Association that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Megan Grosso	No disclosure on file

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