OBJECTIVES: The introduction of fingolimod in 2010 provided neurologists with a newer category of oral Disease Modifying Agent (DMA) to treat Multiple Sclerosis (MS). However, drivers for the selection of fingolimod to treat MS in the early years are not known. The objective of this study was to examine the factors associated with the prescribing of oral fingolimod among individuals with MS in the initial years after market approval.

METHODS: A retrospective longitudinal study was conducted using adults (≥18 years) with MS from IBM MarketScan Commercial Claims and Encounters Database during 2010–2012. Individuals with MS were identified by the presence of ICD-9-CM:340 and a DMA prescription. Based on the index DMA, patients were classified as fingolimod or injectable users. Multivariable logistic regression was preformed to determine the predisposing, enabling, and need factors, conceptualized as per Andersen Behavioral Model (ABM) during the 6-month baseline period, associated with prescribing of fingolimod versus injectable DMA for MS.

RESULTS: The study cohort consisted of 3,125 MS patients; Only 14.46% of the individuals with MS initiated with fingolimod, while the remaining 85.54% initiated with injectable DMAs. Multivariable regression revealed that compared to 2010, the likelihood of prescribing oral DMA increased by 2-3 fold during 2011 and 2012. Patients with ophthalmic issues (adjusted odds ratio [AOR]-2.60;95%CI:2.06-3.27) and heart diseases (AOR-2.16;95%CI:1.61-2.89) were more likely to receive fingolimod. Further, patients with other neurological disorders (AOR-0.50;95%CI:0.38-0.66) were less likely to receive fingolimod. While use of symptomatic medication (for impaired walking [AOR-2.62;95%CI:1.91-3.60], bladder dysfunction [AOR-1.53;95%CI:1.17-2.01], and analgesics [AOR-1.50;95%CI:1.17-1.93]) and neurologist consultation (AOR-1.83;95%CI:1.41-2.37) increased the odds of receiving fingolimod, visits to the emergency department (AOR-0.72;95%CI:0.54-0.98) decreased the odds of receiving fingolimod.

CONCLUSIONS: During the initial years after market approval, nearly one in seven MS patients received oral fingolimod. Patients’ enabling and need factors were the main drivers of oral fingolimod use over injectable DMAs.