Abstract Details

Title Adherence to Riluzole Therapy Improves Time to and Frequency of All Cause Hospitalization in ALS Patients: A Claims-Based Longitudinal Comparative Effectiveness Analysis.

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-022

Objective To assess the comparative effectiveness of riluzole therapy in patients with amyotrophic lateral sclerosis (ALS).

Background Historical studies suggest that riluzole improves survival in patients with ALS, but few studies exist that demonstrate the real world clinical benefit of sustained riluzole therapy.

Design/Methods The study population was derived from Symphony Health, a managed care database comprising over 100 million lives. The study period was Dec 1, 2012 to Nov 30,2017. Patients with a diagnosis of ALS by ICD9 or 10 at any time during the study period, or patients with riluzole dispensings that exceeded 90 days supply AND who did not have a non-ALS diagnosis were included. Riluzole adherence was defined as: High – Medication Possession Ratio (MPR) ≥0.75; Moderate – MPR <0.75; Untreated – no riluzole dispensings. Kaplan-Meier curves were generated to compare time (from the start of enrollment into the plan) to first hospitalization based on riluzole exposure at five years of follow up. Cox regression was conducted to derive age/gender adjusted hazard ratios for first all cause hospitalization.

Results 47,012 patients met the inclusion criteria, and 28,646 all cause first hospitalization events were captured. Among 11,391 highly adherent (MPR ≥0.75) hospitalized patients, median time to first hospitalization was 900 days (95%CI: 883-938 days) versus 579 days (95%CI:500-600 days) for 14,998 untreated hospitalized patients (p<.0001). Results for 2,257 moderately adherent patients were similar (974 days (95%CI:915-1037) to highly adherent patients (NS). Cox regression analysis demonstrated that untreated patients were 40% more likely to be hospitalized versus highly adherent treated patients and moderately adherent treated patients (untreated adj HR: 1.40 [95%CI:1.36-1.43], P<.001).

Conclusions In this real world analysis, sustained riluzole use results in clinically significant prolongation of time to first hospitalization and fewer admissions overall. The data support the observation that riluzole therapy is effective among patients who adhere to the regimen.

Authors/Disclosures
Gilbert J. L'Italien PRESENTER	Gilbert J. L'Italien has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Gilbert J. L'Italien has stock in biohaven pharmaceuticals.
Irfan Qureshi, MD (Biohaven Pharmaceuticals)	Dr. Qureshi has received personal compensation for serving as an employee of Biohaven. Dr. Qureshi has stock in Biohaven Pharmaceuticals.
	No disclosure on file
Zachary Simmons, MD, FAAN (Penn State Hershey Med Center)	Dr. Simmons has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amylyx. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clene. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Insmed. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Simmons has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Corcept. The institution of Dr. Simmons has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. The institution of Dr. Simmons has received research support from MGH. The institution of Dr. Simmons has received research support from Clene. The institution of Dr. Simmons has received research support from NIH via MGH. The institution of Dr. Simmons has received research support from Aburo. The institution of Dr. Simmons has received research support from NIH subaward via Univ of Pennsylvania.

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