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Pharmacotherapy: Pharmacokinetics and Pharmacodynamics (including: ADE, TDM, DUE)
Reasons for changing treatment in multiple sclerosis
  1. A. Pérez-Ricart,
  2. M.J. de Dios García,
  3. M. Alcade Rodrigo,
  4. P. López Méndez,
  5. M.R. Gómez Domingo,
  6. I. Cardona Pascual,
  7. J.C. Juárez Giménez,
  8. J.B. Montoro Ronsano
  1. 1Hospital Universitari Vall d’Hebron, Pharmacy, Barcelona, Spain
  2. 2Hospital Universitari Vall d’Hebron, Neurology, Barcelona, Spain

Abstract

Background Multiple sclerosis (MS) is a disabling disease that affects the central nervous system.

Switching of first-line drugs (interferon β, glatiramer acetate) or initiation of a second-line treatment (natalizumab, mitoxantrone, cyclophosphamide, rituximab) should be considered if suboptimal response is observed with first-line drugs.

Purpose To analyse the treatment pattern and the main reasons for changing MS treatment.

Materials and methods Cross-sectional, retrospective descriptive study in MS patients, in a reference unit, in a tertiary hospital. A sample of 100 patients was analysed (10% of complete MS population) who picked up medicines from the outpatient pharmacy unit, following a database that included demographic and clinical information.

Results 30% of patients had switched treatment once and 7% at least twice (23.3% of the MS population that had changed previously). The main reasons for changing treatment, from initial to second and second to third treatment were: lack of efficacy: 65.4% and 20% respectively; drug withdrawal: 15.4% and 20%; pregnancy: 15.4% and 0%; drug intolerance: 3.8% and 0%; adverse reaction: 0% and 20%; maximum tolerated dose: 0% and 10%. By drugs, main reasons for changing MS treatment, from the initial to second treatment were: Avonex: lack of efficacy (75%) and pregnancy (25%); Betaferon: lack of efficacy (20%) and drug withdrawal (80%); Rebif 22 mcg lack of efficacy (75%) and pregnancy (25%); Rebif 44 mcg: lack of efficacy (100%); Copaxone: lack of efficacy (50%), intolerance (25%) and pregnancy (25%). The treatment mean time was 51±43 months prior to the first change, which decreased to 23.5±21.9 months for the second change of treatment. The mean Expanded Disability Status Scale (EDSS) score increased from 2.5±1.4 at the beginning to 3.9±1.9 in second-line treatment and 5.7±1.8 in third-line treatment.

Conclusions 30% of patients with MS had changed treatment. The main reason was progression of the disease.

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