Utilisation of disease modifying treatment and diversity of treatment pathways in relapsing remitting multiple sclerosis

J Hillen; M Ward; M Slee; T Stanford; E Roughead; L Kalisch Ellett; N Pratt

doi:10.1016/j.msard.2021.103412

Utilisation of disease modifying treatment and diversity of treatment pathways in relapsing remitting multiple sclerosis

Mult Scler Relat Disord. 2022 Jan:57:103412. doi: 10.1016/j.msard.2021.103412. Epub 2021 Nov 18.

Authors

J Hillen¹, M Ward², M Slee³, T Stanford⁴, E Roughead⁴, L Kalisch Ellett⁴, N Pratt⁴

Affiliations

¹ Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia. Electronic address: jodie.hillen@unisa.edu.au.
² Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia; Pharmacy Education, Clinical and Health Sciences, University of South Australia, Australia.
³ College of Medicine and Public Health, Flinders University, Adelaide, Australia.
⁴ Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Australia.

PMID: 34856498
DOI: 10.1016/j.msard.2021.103412

Abstract

Background: There is minimal information on the utilisation of Disease Modifying Treatment (DMTs) for multiple sclerosis. The appropriate and safe use of medicines is informed by utilisation studies. Outcomes can inform health interventions to improve appropriate use of medicines and post marketing surveillance activities to improve safety.

Objective: To evaluate utilisation and treatment patterns of disease modifying treatments (DMTs) for relapsing remitting multiple sclerosis (RRMS).

Methods: A representative sample of the Australian pharmaceutical benefits scheme data were analysed (2006-2016). Demographics of incident users and trends in incident and prevalent users were determined. Individual patient treatment pathways were determined by sequential initiation of medicines in two different periods (2006-2013 and 2014-2019).

Results: There were 20,660 patients with at least one dispensing of a DMT for RRMS during the study period (median age 41 years, 75% female). Incident and prevalent use increased by 20% and 88%, respectively. The market was responsive to 13 new listings of DMTs over the study period. Sequential treatment was found for 66% of initiators in 2006-2013 and 28.5% of initiators in 2014-2019. Diverse treatment pathways were found, with 278 and 93 unique sequences in 2006-2013 and 2014-2019, respectively.

Conclusion: The availability of new DMTs has influenced both initial treatment choice and prevalence of users. Individualised treatment patterns and exposure to multiple medicines over time will challenge traditional pharmacovigilance systems.

Keywords: Drug utilisation study; Mulitple Sclerosis; Therapeutics; Treatment Patterns.

MeSH terms

Adult
Australia / epidemiology
Female
Humans
Male
Multiple Sclerosis*
Multiple Sclerosis, Relapsing-Remitting* / drug therapy
Multiple Sclerosis, Relapsing-Remitting* / epidemiology