Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis

Background: 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: The objective of this study was to examine the facto...

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Autores principales:	Jagadeswara Rao Earla, George J. Hutton, J. Douglas Thornton, Hua Chen, Michael L. Johnson, Rajender R. Aparasu
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Multiple sclerosis Disease modifying agent (DMA) Fingolimod Oral DMA Injectable DMA Treatment selection Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/dd171efef64c4848963a8750a827eb13
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spelling	oai:doaj.org-article:dd171efef64c4848963a8750a827eb132021-11-04T04:44:54ZFactors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis2667-276610.1016/j.rcsop.2021.100021https://doaj.org/article/dd171efef64c4848963a8750a827eb132021-06-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2667276621000214https://doaj.org/toc/2667-2766Background: 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: The objective of this study was to examine the factors associated with fingolimod prescribing in the initial years after the market approval. Methods: 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: 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: 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.Jagadeswara Rao EarlaGeorge J. HuttonJ. Douglas ThorntonHua ChenMichael L. JohnsonRajender R. AparasuElsevierarticleMultiple sclerosisDisease modifying agent (DMA)FingolimodOral DMAInjectable DMATreatment selectionPharmacy and materia medicaRS1-441ENExploratory Research in Clinical and Social Pharmacy, Vol 2, Iss , Pp 100021- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Multiple sclerosis Disease modifying agent (DMA) Fingolimod Oral DMA Injectable DMA Treatment selection Pharmacy and materia medica RS1-441
spellingShingle	Multiple sclerosis Disease modifying agent (DMA) Fingolimod Oral DMA Injectable DMA Treatment selection Pharmacy and materia medica RS1-441 Jagadeswara Rao Earla George J. Hutton J. Douglas Thornton Hua Chen Michael L. Johnson Rajender R. Aparasu Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
description	Background: 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: The objective of this study was to examine the factors associated with fingolimod prescribing in the initial years after the market approval. Methods: 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: 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: 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.
format	article
author	Jagadeswara Rao Earla George J. Hutton J. Douglas Thornton Hua Chen Michael L. Johnson Rajender R. Aparasu
author_facet	Jagadeswara Rao Earla George J. Hutton J. Douglas Thornton Hua Chen Michael L. Johnson Rajender R. Aparasu
author_sort	Jagadeswara Rao Earla
title	Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
title_short	Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
title_full	Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
title_fullStr	Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
title_full_unstemmed	Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
title_sort	factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/dd171efef64c4848963a8750a827eb13
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Factors associated with oral fingolimod use over injectable disease- modifying agent use in multiple sclerosis

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