The clinical and cost impact of switching to fingolimod versus other first line injectable disease-modifying therapies in patients with relapsing multiple sclerosis

Abstract

Background: There is limited evidence on the effectiveness and healthcare costs of switching to fingolimod versus another first line injectable therapy (FLIT) in patients with relapsing multiple sclerosis (RMS) who have already been treated with FLIT.

Objective: The objectives of the study were to assess the annualized relapse rate (ARR), socio-demographic and clinical characteristics, persistence and adherence rates, healthcare resource utilization and cost among patients with RMS who either switch to fingolimod or another FLIT in routine clinical practice.

Methods: A multicenter, observational, retrospective chart review was conducted across eight clinics in Canada between 1 May 2011 and 30 June 2013. The data was collected from two cohorts: patients who switched to fingolimod and patients who switched to FLIT from a previous FLIT.

Results and conclusions: A total of 124 patients were included in the study: 82 and 42 switched to fingolimod and FLIT, respectively. There were no significant differences in the patient characteristics at the date of switch except for number of previous disease-modifying therapies (DMTs) which was higher in the fingolimod cohort (fingolimod: 1.52; FLIT: 1.10, p < .001). The ARR during the first year of switching was numerically higher in the FLIT cohort compared to the fingolimod cohort (FLIT: 0.9 [95% CI 0.3–1.6]; fingolimod: 0.3 [95% CI 0.1–0.5]). The negative binomial model adjusted for the number of previous DMTs confirmed a statistically significant difference in ARR between the fingolimod and FLIT cohorts at 12 months of follow-up (p = .012). In the fingolimod cohort, 20.7% of patients experienced at least one relapse compared to 38.1% in the FLIT cohort. In both groups, a high proportion of patients (>90%) showed good treatment adherence (≥80% of prescribed doses).

Keywords:

• Multiple sclerosis
• Fingolimod
• disease-modifying therapy
• switch
• adherence
• resource utilization
• Canada

Transparency

Declaration of funding

The study was funded by Novartis Pharma AG, Basel, Switzerland.

Author contributions: M.S.F., P.D., F.G.M., L.L., G.V., N.L., V.K. and H.R.N. were involved in the analysis and interpretation of the data; and preparation, review and approval of the manuscript. R.S. and P.H. were involved in the design of the study; analysis and interpretation of the data; and preparation, review and approval of the manuscript.

Declaration of financial/other relationships

M.S.F. has disclosed that he has received research or educational grants from Genzyme Canada; received honoraria or consultation fees from Actelion, Bayer Healthcare, BiogenIdec, Chugai, Clene Nanomedicine, EMD Canada, Genzyme, Merck Serono, Novartis, Hoffman La-Roche, Sanofi-Aventis and Teva Canada Innovation; is a member of a company advisory board, board of directors or other similar group for Actelion, Bayer Healthcare, BiogenIdec, Clene Nanomedicine, Hoffman La-Roche, Merck Serono, MedDay, Novartis and Sanofi-Aventis; and participated in a company sponsored speaker’s bureau for Sanofi-Genzyme.

P.D. has disclosed that he has received grants, personal fees and non-financial support from EMD Serono, Genzyme, Biogen-Idec and Novartis outside the submitted work. F.G.M. has disclosed that he has received grant funding from Novartis, Chugai, Opexa, Serono, Biogen, Roche, Genzyme, Abbott and Actelion. L.L. has disclosed that she has served on advisory boards, received honoraria, conducted clinical trials with and received research funding from Allergan, Biogen Canada, Serono Canada, Teva Neurosciences, Schering (Berlex), BioMS, Bayer Canada, Novartis Canada, Sanofi Aventis, Genzyme Canada and Roche Canada outside the submitted work. G.V. has disclosed that she has received personal compensation for consulting and research support for Biogen Idec, Genzyme, Novartis, Roche, Serono Merck and Teva Neuroscience. N.L. has disclosed that she is an IQVIA employee and received funds from Novartis to conduct the study.

H.R.N., R.S. and P.H. have disclosed that they are employees of Novartis Pharmaceuticals Canada Inc. V.K. has disclosed that he is an employee of Novartis Healthcare Private Limited, Hyderabad, India.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no relevant financial or other relationships to disclose.