Comparative Adherence Trajectories of Oral Fingolimod and Injectable Disease Modifying Agents in Multiple Sclerosis

Jagadeswara R Earla,1 George J Hutton,2 J Douglas Thornton,1 Hua Chen,1 Michael L Johnson,1 Rajender R Aparasu1 1Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA; 2Department of Neurology, Baylor College of Medicine, Houston, TX, USACorrespondence: Rajender R AparasuPharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Texas Medical Center, 4849 Calhoun Road, Houston, TX 77204-5047, USATel +1 832-842-8374Email rraparasu@uh.eduBackground: Oral fingolimod is convenient to use than injectable disease modifying agents (DMAs) in patients with multiple sclerosis (MS). However, the existing literature regarding the comparative adherence trajectories between oral fingolimod and injectable DMAs is limited.Objective: To compare the adherence trajectories between oral DMA, fingolimod, and injectable DMAs in patients with MS.Methods: A retrospective longitudinal study was conducted using adults (≥ 18 years) with MS (ICD-9-CM: 340 and a DMA prescription) from the IBM MarketScan Commercial Claims and Encounters Database between 2010 and 2012. Patients were grouped into oral fingolimod or injectable DMA users based on the index DMA among patients with MS. The annual DMA adherence trajectories, based on the proportion of days covered (PDC), were examined using group-based trajectory modeling (GBTM) during the one-year follow-up period after treatment initiation. Multivariable multinomial logistic regression using stabilized inverse probability treatment weights (IPTW) was performed to assess the association between the DMA route of administration (Oral vs Injectable) and the adherence trajectory groups. The balance of covariates between oral and injectable DMAs before and after IPTW was checked against a standardized difference threshold of 0.25.Results: The study cohort consisted of 1,700 MS patients who were initiated with oral (15.8%) or injectable (84.2%) DMAs between 2010 and 2012. The adherence rates (PDC≥ 0.8) in oral fingolimod and injectable DMA users were found to be 64.7% and 50.8%, respectively. The GBTM grouped individuals in the study cohort into three adherence trajectories – rapid discontinuers (23.5%), complete adherers (49.9%), and slow decliners (26.6%). The multinomial logistic regression model with stabilized IPTW revealed that oral fingolimod users had higher odds to be a complete adherer (adjusted odds ratio [AOR]: 2.78, 95% CI: 1.85– 4.16) or a slow discontinuer (AOR: 2.62, 95% CI: 1.70– 4.05) than injectable DMA users.Conclusions: Oral DMA fingolimod was associated with better adherence than injectable DMAs across group-based trajectories. Further research is warranted to evaluate the adherence trajectories with newer oral DMAs introduced in the last decade for MS.Keywords: group based trajectory modelling, GBTM, adherence trajectory, multiple sclerosis, disease modifying agent, DMA, fingolimod, injectable DMA