Category: Fellows Posters
Disease Modifying Therapies (DMTs) have the potential to alter the natural history of Multiple Sclerosis (MS) by decreasing the frequency and severity of relapses, decreasing the number of new and enlarging brain lessons and slowing disability progression
DMTs effectiveness and safety measurement in clinical practice can be a hard task. On this matter, discontinuation rate can be a proper effectiveness indicator. Therefore, our goal is to analyze how many of the patients treated in our hospital have changed DMT in a year, and if so, the reasons for the change.
A retrospective, observational study was conducted in patients with relapsing-remitting multiple sclerosis (RRMS) who changed (pretreated patients) DMT during 2018.
Variables analyzed were: demographics (sex and age), number of previous DMTs, last DMT received and the length of time on the drug, Expanded Disability Status Scale (EDSS) when changing and reasons for treatment discontinuation. Data were obtained from electronic health record.
By the end of 2017 there were 534 patients undergoing treatment with DMTs (34% with interferon-β (INFβ), 22.1% glatiramer acetate (GA), 12.1% teriflunomide (TF), 11% dimethyl fumarate (DF), 9.1% fingolimod (FGL), 8.6% natalizumab (NTZ) and 3.1% alemtuzumab (ALZ)). 72.46% were women, the median age was 40 years (17- 61) and median EDSS at the moment of change 2 (0-6). 65.4% of the patients had been treated with one DMT before, 23.4% with 2, 5.7% with 3, 4.2% with 4 and 1.3% had 5. 70 patients (15.55%) switched to another DMT in 2018. 25 (20.8%) patients treated with GA changed DMT, 5(12.19%) of those with NTZ, 22(12%) with INFβ, 7(10.6%) with TF, 6(10.2%) with DF, 4(7.69%) with FGL and 1(7.14%) with ALZ. Median treatment duration was: 54 (25-56) months with NTZ, 39 (11-151) with GA, 15.5 (11-70) with FGL, 23 (6-81) with INFβ, 17 (8-29) with TF, 12 with ALZ and 9 (1-27) with DF. The main reasons for discontinuing a drug were; 57% inefficacy, 34.4% adverse effects, 4.3% fear if needles and 4.3% PML risk. Changes due to inefficiency were 17/25 with GA, 6/7 with TF, 10/22 with INFβ, 2/6 with DF, 2/4 with FGL and 2/5 with NTZ.
DMT discontinuation was very low in comparison to other series (15.55%). Most of the patients whose treatment was discontinued were being treated with a first-line DMTs (84%). Those treated with with GA changed the most (20%), although they had been under treatment for more time (39 (11-151 months).
The main reason for changing TF and GA treatment was inefficacy. In the case of NTZ and DMF, risk of PML and adverse effects were the main reasons to discontinuation, respectively.