Trends in disease-modifying therapy use in patients with multiple sclerosis using a 10-year population-based cohort study in France

ABSTRACT

Background

The availability of new disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) provides an opportunity for improving outcomes but makes disease management more complex. Our study aimed to describe changes in therapeutic practices over the period 2009–2018 and measure the impact of the arrival of oral DMTs on the use of injectable DMTs.

Methods

Data were extracted from a representative 1/97 sample of the French population covered by the healthcare insurance system. Study period was set from 1 January 2009 to 31 December 2018. Four periods of MS identification were defined (before 2009, 2009–2011, 2012–2015, and 2016–2018).

Results

Overall, 1,508 patients with MS were included, of whom 876 (58.1%) were treated at least once over the study period. Untreated patients were older and had more comorbidities than treated ones. First-line DMTs were the most frequent initial DMT (78.5%), and a shift has operated from injectable to oral drugs over time. The proportion of patients receiving several DMTs increased with the number of available drugs. End 2018, relative parts of all DMTs were almost equal.

Conclusions

This study provides valuable insights into the real-world use of DMTs and changes that have operated over time.

KEYWORDS:

• Disease-modifying therapies
• health administrative database
• multiple sclerosis
• time-series
• untreated

Data availability statement

According to data protection and the French regulation, the authors cannot publicly release the data from the French national health data system (SNDS). However, a request for data reuse may be made and would require the obtention of prior approval of the French regulatory authorities (https://www.snds.gouv.fr/SNDS/Processus-d-acces-aux-donneesandhttps://www.indsante.fr/).

Author contributions

Conception and design: S. Leblanc, E. Leray. Analysis and interpretation of the data: S. Leblanc, M. Lefort, E. Le Page, L. Michel, E. Leray. The drafting of the paper and/or revising it critically for intellectual content: S. Leblanc, M. Lefort, E. Le Page, L. Michel, E. Leray. The final approval of the version to be published: S. Leblanc, M. Lefort, E. Le Page, L. Michel, E. Leray. All authors agree to be accountable for all aspects of the work.

Declaration of interests

E. Le Page reports consulting and lecture fees or travel grants from Biogen, Sanofi Aventis, Teva, Merck Serono, Novartis, and Roche, nothing related to the contents of the present work. L. Michel reports research grants from the EDMUS Foundation and the ARSEP Foundation; consulting and lecture fees or travel grants from Biogen, Bristol-Myers-Squibb, Genzyme Sanofi, Merck Serono, Novartis, and Roche, nothing related to the contents of the present work. E. Leray reports research grants from the French National Agency for Medicines and Health Product Safety (ANSM), the EDMUS Foundation, and the ARSEP Foundation; consulting and lecture fees or travel grants from Biogen, Bristol-Myers-Squibb, Genzyme Sanofi, MedDay Pharmaceuticals, Merck Serono, Novartis, and Roche, nothing related to the contents of the present work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by ‘Institut des Neurosciences Cliniques de Rennes’, France. (Call for proposals, 2018).