多发性硬化症患者开始使用高效改变病情药物而非中效改变病情药物的相关因素

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-09-19 DOI:10.1016/j.msard.2024.105896

Jieni Li , George J. Hutton , Tyler J. Varisco , Ying Lin , Ekere J. Essien , Rajender R. Aparasu

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引用次数: 0

摘要

背景面对多种治疗方案，选择最初的疾病修饰药物（DMA）可能是控制多发性硬化症（MS）的关键。常见的治疗策略建议患者开始使用中等疗效的疾病修饰药物（meDMAs），而其他治疗策略则主张开始使用高效的疾病修饰药物（heDMAs）。本研究评估了多发性硬化症患者开始使用 heDMAs 与 meDMAs 的相关因素。方法使用 Merative MarketScan 商业索赔数据库进行了一项回顾性队列研究。确定了 2016 年至 2019 年期间处方≥1 次 DMA 的成年（18-64 岁）多发性硬化症患者。患者根据其最早的 DMA 处方被分为 heDMA 或 meDMA 使用者，并有 12 个月的清洗期。所有协变量均在指数 DMA 日期之前的 12 个月基线期间进行测量。结果共有 10,003 名符合条件的多发性硬化症患者，其中大多数使用者为女性（74.92%）、中年人（35-54 岁，58.97%），并加入了首选提供商组织（PPO，53.10%）的医疗保健计划。共有 2293 名（22.92%）多发性硬化症患者开始使用 heDMAs。多变量逻辑回归模型显示，男性患者（调整后的几率比 [aOR]：1.46，95 % 置信区间 [CI]：1.30-1.64）启动 heDMAs 的几率更高。同时，服用膀胱功能障碍药物（aOR：1.39，95% 置信区间：1.21-1.61）、疲劳药物（aOR：1.77，95% 置信区间：1.44-2.17）和行走障碍（aOR：1.62，95% 置信区间：1.42-1.86）的患者更有可能开始接受 heDMAs 治疗。相比之下，Elixhauser 合并症评分较高、有感觉症状（aOR：0.47，95 %CI：0.42-0.53）、视觉症状（aOR：0.63，95 %CI：0.54-0.73）和脑干症状（aOR：0.81，95 %CI：0.67-0.97）的患者不太可能接受 heDMAs 治疗。人口统计学和临床因素都会影响患者对 heDMA 的选择。还需要做更多的工作来了解选择 heDMAs 而非 meDMAs 对个性化 DMA 治疗的不同价值。

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Factors associated with the initiation of high-efficacy disease-modifying agents over moderate-efficacy disease-modifying agents in multiple sclerosis

Background

With multiple treatment options, choosing the initial disease-modifying agent (DMA) could be crucial to managing multiple sclerosis (MS). Common treatment strategies recommend starting patients with moderate-efficacy disease-modifying agents (meDMAs), while others advocate initiating high-efficacy disease-modifying agents (heDMAs). However, limited real-world evidence exists regarding the factors associated with utilizing differing treatment strategies in the MS.

Objective

This study evaluated the factors associated with the initiation of heDMAs in comparison to meDMAs among patients with MS.

Methods

A retrospective cohort study was conducted using the Merative MarketScan Commercial Claims Database. Adult (18–64 years) MS patients with ≥1 DMA prescription were identified from 2016 to 2019. Patients were classified as incident heDMA or meDMA users based on their earliest DMA prescription, with a 12-month washout period. All covariates were measured during the 12-month baseline before the index DMA date. A multivariable logistic regression model, guided by the Andersen Behavioral Model, was applied to examine the predisposing, enabling, and need factors associated with using heDMAs over meDMAs.

Results

There were 10,003 eligible MS patients, with the majority of users being female (74.92 %), middle-aged adults (35–54 years, 58.97 %), and enrolled in the Preferred Provider Organization (PPO, 53.10 %) healthcare plan. Overall, 2293 (22.92 %) MS patients initiated heDMAs. The multivariable logistic regression model revealed that male patients (adjusted odds ratio [aOR]: 1.46, 95 % Confidence Interval [CI]: 1.30–1.64) had higher odds of initiating heDMAs. Meanwhile, patients with bladder dysfunction medications (aOR: 1.39, 95% CI: 1.21-1.61), fatigue medications (aOR: 1.77, 95 %CI: 1.44–2.17), and impaired walking (aOR: 1.62, 95 %CI: 1.42–1.86) were more likely to initiate treatment with heDMAs. In contrast, patients with higher Elixhauser comorbidities scores, sensory symptoms (aOR: 0.47, 95 %CI: 0.42–0.53), visual symptoms (aOR: 0.63, 95 %CI: 0.54–0.73), and brainstem symptoms (aOR: 0.81, 95 %CI: 0.67–0.97) were less likely to be prescribed with heDMAs.

Conclusion

The study found that approximately one in four MS patients initiated heDMAs. Both demographic and clinical factors influenced the selection of heDMA. More work is needed to understand the differential value of selecting heDMAs over meDMAs for personalizing DMA treatment.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.