Discontinuation of Disease-Modifying Therapies in Older Adults with Multiple Sclerosis
Author(s)
Jieni Li, MPH, PhD, Rajender Aparasu, PharmD, PhD.
Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA.
OBJECTIVES: Disease-modifying therapy (DMT) use in older adults with multiple sclerosis (MS) is debated due to limited efficacy data, safety concerns, and high costs. Therefore, this study examined the nature and extent of discontinuation of DMTs in older adults with MS.
METHODS: This retrospective cohort study involved Medicare beneficiaries (≥65 years) with MS who used DMTs from 2011 to 2021 with a Proportion of Days Covered (PDC) of ≥80% for 12 months following the earliest DMT prescription. Patients who discontinued DMTs for ≥12 consecutive months after this initial period were classified into the discontinuation cohort. Those who maintained a PDC ≥80% for 24 months after the initial period were considered the continuation cohort. Patients with continuous Medicare Part A, B, and D enrollment but no Part C enrollment throughout the study period were included. Descriptive analyses were used to evaluate DMT discontinuation and compare characteristics with those who continued.
RESULTS: Among 64,618 Medicare beneficiaries with DMT use, 38,706 had an initial PDC of ≥80%. Among them, 1,025 (11.79%) discontinued DMTs for ≥12 months, and 7,669 (88.21%) continued DMTs. More patients from the discontinuation cohort were older than 70 years (39.02% vs. 34.44%, p=0.0057), disabled (39.51% vs. 36.00%, p<0.0001), and had frequent relapses (annualized relapse rate: 0.52 vs. 0.46, p=0.0001). Discontinuation patients also had more comorbidities (≥5 comorbidities: 46.42% vs. 38.31%, p<0.0001), higher levels of frailty (moderate to severe frail: 14.54% vs. 9.06, p<0.0001), more serious infection events (11.90% vs. 7.37%, p<0.0001), and more hospitalization during the baseline period (22.44% vs. 13.65%, p<0.0001).
CONCLUSIONS: Most older adults with MS persisted with DMT use, but there were significant differences in sociodemographic and clinical characteristics from those who discontinued. Given the efficacy and safety concerns, further research is warranted to evaluate the consequences of DMT discontinuation in older adults with MS.
METHODS: This retrospective cohort study involved Medicare beneficiaries (≥65 years) with MS who used DMTs from 2011 to 2021 with a Proportion of Days Covered (PDC) of ≥80% for 12 months following the earliest DMT prescription. Patients who discontinued DMTs for ≥12 consecutive months after this initial period were classified into the discontinuation cohort. Those who maintained a PDC ≥80% for 24 months after the initial period were considered the continuation cohort. Patients with continuous Medicare Part A, B, and D enrollment but no Part C enrollment throughout the study period were included. Descriptive analyses were used to evaluate DMT discontinuation and compare characteristics with those who continued.
RESULTS: Among 64,618 Medicare beneficiaries with DMT use, 38,706 had an initial PDC of ≥80%. Among them, 1,025 (11.79%) discontinued DMTs for ≥12 months, and 7,669 (88.21%) continued DMTs. More patients from the discontinuation cohort were older than 70 years (39.02% vs. 34.44%, p=0.0057), disabled (39.51% vs. 36.00%, p<0.0001), and had frequent relapses (annualized relapse rate: 0.52 vs. 0.46, p=0.0001). Discontinuation patients also had more comorbidities (≥5 comorbidities: 46.42% vs. 38.31%, p<0.0001), higher levels of frailty (moderate to severe frail: 14.54% vs. 9.06, p<0.0001), more serious infection events (11.90% vs. 7.37%, p<0.0001), and more hospitalization during the baseline period (22.44% vs. 13.65%, p<0.0001).
CONCLUSIONS: Most older adults with MS persisted with DMT use, but there were significant differences in sociodemographic and clinical characteristics from those who discontinued. Given the efficacy and safety concerns, further research is warranted to evaluate the consequences of DMT discontinuation in older adults with MS.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PCR73
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Neurological Disorders