Background New frontline oral therapies for relapsing remitting multiple sclerosis (RRMS) are available. The change to the oral route of administration could increase adherence.¹

Purpose The aim was to assess patient adherence to new oral disease modifying therapies (oDMT), dimethyl-fumarate (DMF) and teriflunomide (TE), in comparison with prior injectable therapies (iDMT).

Material and methods This was a descriptive, observational and prospective study conducted between June 2015 and March 2016, in a university hospital of 1100 beds. RRMS patients switched from iDMT (interferon-beta 1a/1b or glatiramer acetate (GA)) to new oDMT were included. Sociodemographic and clinical variables were obtained by structured interview, review of medical records and pharmaceutical database. Adherence, measured by medication possession ratio (MPR) and expressed as a percentage, was compared for oDMT versus iDMT. Adherence was considered if MPR ≥90%. SPSS (V.15) software was used for statistical analysis.

Results 38 patients were switched from iDMT to DMF (n=20) or TE (n=18). Women 87.8%, mean age (SD) 39.2 (8.5) years, mean disease duration (SD) 6.0 (5.0) years, median EDSS (range) 2 (0–6.5) and annualised relapse rate over the past year 0.7±0.8. 66.7% of patients were switched from interferon-beta and 33.3% from GA. Prior mean treatment duration (SD) was 423.4 (167.2) days. Switched patients received one DMT (63.6%) or two DMT (36.4%). The main reasons for change were ineffective (59.4%) and intolerance (40.6%). In 4 patients oDMT were stopped in the first 2 months: 1 patient on TE due to pregnancy, 4 patients on DMF due to GI intolerance (n=3) and lymphopenia (n=1). Mean oDMT duration (SD) was 166.5 (59.3) days. MPR to iDMT was 85.2% versus 98.1% for oDMT (p<0.001). No differences between the two oDMT were observed. iDMT adherence among patients who switched to TE was slightly lower (83.4%) versus those who passed DMF (85.7%)(p>0.05). Adherence ≥90% was observed in 70% of patients on iDMT and in 100% on oDMT.

Conclusion Patients on oDMT had better adherence than those previously treated with iDMT. This change may have an important impact on disease control. More real world data are necessary to evaluate long term adherence to oDMT.

References and/or acknowledgements 1. Bergvall N, et al. Persistence and adherence to fingolimod compared with other disease-modifying therapies for the treatment of multiple sclerosis: a retrospective US claims database analysis. J Med Econ2014;17:696–707.

No conflict of interest