Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis.
ABM, The Andersen Behavioral Model
AHRQ, Agency for Healthcare Research and Quality
AOR, Adjusted Odds Ratio
AV, Atrioventricular
CCS, Clinical Classification System
CDHP, Consumer Directed Health Plan
CLD, Chronic Lung Disease
DMA, Disease-modifying agent
DME, Durable Medical Equipment
Disease modifying agent (DMA)
ED, Emergency Department
EDSS, Expanded Disability Status Score
EPO, Exclusive Provider Organization
FDA, Food and Drug Administration
FIN, Fingolimod
Fingolimod
HCPCS, The Healthcare Common Procedure Coding System
HDHP, High Deductible Health Plan
HMO, Health Maintenance Organization
ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification
INJ, Injectable DMAs
Injectable DMA
MRI, Magnetic Resonance Imaging
MS, Multiple Sclerosis
Multiple sclerosis
NDC, National Drug Code
Oral DMA
POS, Point-of-service
PPO, Preferred Provider Organization
SD, Standard Deviation
Treatment selection
Journal
Exploratory research in clinical and social pharmacy
ISSN: 2667-2766
Titre abrégé: Explor Res Clin Soc Pharm
Pays: United States
ID NLM: 9918266300706676
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
21
12
2020
revised:
02
03
2021
accepted:
02
05
2021
entrez:
28
4
2022
pubmed:
29
4
2022
medline:
29
4
2022
Statut:
epublish
Résumé
Fingolimod is the first approved oral disease-modifying agent (DMA) in 2010 to treat Multiple Sclerosis (MS). There is limited real-world evidence regarding the determinants associated with fingolimod use in the early years. The objective of this study was to examine the factors associated with fingolimod prescribing in the initial years after the market approval. A retrospective, longitudinal study was conducted involving adults (≥18 years) with MS from the 2010-2012 IBM MarketScan. Individuals with MS were selected based on ICD-9-CM: 340 and a newly initiated DMA prescription. Based on the index/first DMA prescription, patients were classified as fingolimod or injectable users. All covariates were measured during the six months baseline period prior to the index date. Multivariable logistic regression was performed to determine the predisposing, enabling, and need factors, conceptualized as per the Andersen Behavioral Model (ABM), associated with prescribing of fingolimod versus injectable DMA for MS. The study cohort consisted of 3118 MS patients receiving DMA treatment. Of which, 14.4% of patients with MS initiated treatment with fingolimod within two years after the market entry, while the remaining 85.6% initiated with injectable DMAs. Multivariable regression revealed that the likelihood of prescribing oral DMA increased by 2-3 fold during 2011 and 2012 compared to 2010. Patients with ophthalmic (adjusted odds ratio [aOR]-2.60), heart (aOR-2.21) and urinary diseases (aOR-1.37) were more likely to receive fingolimod. Patients with other neurological disorders (aOR-0.50) were less likely to receive fingolimod than those without neurological disorders. Use of symptomatic medication (for impaired walking (aOR-2.60), bladder dysfunction (aOR-1.54), antispasmodics (aOR-1.48), and neurologist consultation (aOR-1.81) were associated with higher odds of receiving fingolimod. However, patients with non-MS associated emergency visits (aOR-0.64) had lower odds of receiving fingolimod than those without emergency visits. During the initial years after market approval, patients with highly active MS were more likely to receive oral fingolimod than injectable DMAs. More research is needed to understand the determinants of newer oral DMAs.
Sections du résumé
Background
UNASSIGNED
Fingolimod is the first approved oral disease-modifying agent (DMA) in 2010 to treat Multiple Sclerosis (MS). There is limited real-world evidence regarding the determinants associated with fingolimod use in the early years.
Objective
UNASSIGNED
The objective of this study was to examine the factors associated with fingolimod prescribing in the initial years after the market approval.
Methods
UNASSIGNED
A retrospective, longitudinal study was conducted involving adults (≥18 years) with MS from the 2010-2012 IBM MarketScan. Individuals with MS were selected based on ICD-9-CM: 340 and a newly initiated DMA prescription. Based on the index/first DMA prescription, patients were classified as fingolimod or injectable users. All covariates were measured during the six months baseline period prior to the index date. Multivariable logistic regression was performed to determine the predisposing, enabling, and need factors, conceptualized as per the Andersen Behavioral Model (ABM), associated with prescribing of fingolimod versus injectable DMA for MS.
Results
UNASSIGNED
The study cohort consisted of 3118 MS patients receiving DMA treatment. Of which, 14.4% of patients with MS initiated treatment with fingolimod within two years after the market entry, while the remaining 85.6% initiated with injectable DMAs. Multivariable regression revealed that the likelihood of prescribing oral DMA increased by 2-3 fold during 2011 and 2012 compared to 2010. Patients with ophthalmic (adjusted odds ratio [aOR]-2.60), heart (aOR-2.21) and urinary diseases (aOR-1.37) were more likely to receive fingolimod. Patients with other neurological disorders (aOR-0.50) were less likely to receive fingolimod than those without neurological disorders. Use of symptomatic medication (for impaired walking (aOR-2.60), bladder dysfunction (aOR-1.54), antispasmodics (aOR-1.48), and neurologist consultation (aOR-1.81) were associated with higher odds of receiving fingolimod. However, patients with non-MS associated emergency visits (aOR-0.64) had lower odds of receiving fingolimod than those without emergency visits.
Conclusions
UNASSIGNED
During the initial years after market approval, patients with highly active MS were more likely to receive oral fingolimod than injectable DMAs. More research is needed to understand the determinants of newer oral DMAs.
Identifiants
pubmed: 35481133
doi: 10.1016/j.rcsop.2021.100021
pii: S2667-2766(21)00021-4
pmc: PMC9031432
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100021Informations de copyright
© 2021 The Author(s).
Déclaration de conflit d'intérêts
None.
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