The effect of oral immunomodulatory therapy on treatment uptake and persistence in multiple sclerosis

Matthew Warrender-Sparkes, Tim Spelman, Guillermo Izquierdo, Maria Trojano, Alessandra Lugaresi, François Grand'Maison, Eva Havrdova, Dana Horakova, Cavit Boz, Celia Oreja-Guevara, Raed A Alroughani, Gerardo Iuliano, Pierre Pascal Duquette, Marc Girard, Murat Terzi, Raymond Hupperts, Pierre Grammond, Thor Petersen, Ricardo Fernandez-Bolaños, Marcela FiolEugenio Pucci, Jeannette Lechner-Scott, Freek Verheul, Edgardo Cristiano, Vincent Van Pesch, Tatjana Petkovska-Boskova, Fraser G A Moore, Ilya Kister, Roberto Bergamaschi, Maria Laura Saladino, Mark Slee, Michael Barnett, Maria Pia Amato, Cameron Shaw, Neil Shuey, Carolyn Young, Orla M Gray, Ludwig D Kappos, Helmut Butzkueven, Tomas Kalincik, Vilija G Jokubaitis

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35 Citations (Scopus)


Objective: We aimed to analyse the effect of the introduction of fingolimod, the first oral disease-modifying therapy, on treatment utilisation and persistence in an international cohort of patients with multiple sclerosis (MS). Methods: MSBASIS, a prospective, observational sub-study of the MSBase registry, collects demographic, clinical and paraclinical data on patients followed from MS onset (n=4718). We conducted a multivariable conditional risk set survival analysis to identify predictors of treatment discontinuation, and to assess if the introduction of fingolimod has altered treatment persistence. Results: A total of 2640 patients commenced immunomodulatory therapy. Following the introduction of fingolimod, patients were more likely to discontinue all other treatments (hazard ratio 1.64, p<0.001) while more patients switched to fingolimod than any other therapy (42.3% of switches). Patients switched to fingolimod due to convenience. Patients treated with fingolimod were less likely to discontinue treatment compared with other therapies (p<0.001). Female sex, country of residence, younger age, a high Expanded Disability Status Scale score and relapse activity were all independently associated with higher rates of treatment discontinuation. Conclusion: Following the availability of fingolimod, patients were more likely to discontinue injectable treatments. Those who switched to fingolimod were more likely to do so for convenience. Persistence was improved on fingolimod compared to other medications.

Original languageEnglish
Pages (from-to)520-532
Number of pages13
JournalMultiple Sclerosis Journal
Issue number4
Publication statusPublished - 1 Apr 2016


  • disease-modifying therapy
  • fingolimod
  • medication persistence
  • MSBase
  • Multiple sclerosis

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