gms | German Medical Science

Background: Non-compliance in drug therapy is considered a significant source of waste in health care systems. For treatment of multiple sclerosis, a new generation of high-cost disease modifying therapies (DMT) have come to market in the last decade. Besides offering new active ingredients and thus increased treatment options, the mode of administration of these DMT has altered from injection to oral administration. In this study, we analyze new product development for treatments of multiple sclerosis (MS) patients and the associations with adherence and compliance behavior. One potential determinant of adherence is the extent of technological progress embodied in, or quality of, the drug agent. Overall drug quality is reflected by a set of characteristics in which an advancement may be achieved in one or multiple dimensions, most importantly the active ingredient that defines efficacy. Beyond that, there are additional dimensions like side-effect profiles or ease of drug administration that comprise the quality of a product, all of which could improve adherence and persistence of patients. The objective of this study was to analyze the impact of new product development in disease-modifying drug therapy on medication adherence and persistence in MS patients in Germany.

Materials and Methods: We performed a retrospective cross-sectional analysis using pharmacy data from over 2 million patients. We analyzed how the likelihood of adhering to and persisting with MS therapy depends on the use of new generation disease modifying therapies (DMT) compared to standard therapy. We assessed the likelihood to adhere to (medicines possession ratio >0.8) and discontinue (a gap occurs in medication supply in the range of one-fold duration of the previous prescription) by the type of drug used (new generation DMT vs. standard therapy). We estimated a Bayesian logistic regression model, assuming a Bernoulli distribution as prior for the likelihood to discontinue/adhere and normal distribution as prior of the parameter estimates. We controlled for dosage frequency, treatment complexity and socioeconomic status (age, gender, income, insurance status). We accounted for switching behavior from standard to new generation DMT.

Results: We identified 582 MS patients filling DMT prescriptions between 2012 and 2015. 184 used the innovation. 120 switched from standard to innovation. The likelihood of adhering was positively associated with patients using the innovations compared to standard therapy (mean odds ratio (OR): 2.67). Patients using the new DMT from the start were less likely to discontinue drug therapy (OR: 0.5). For patients that switched to the innovation, the likelihood to discontinue was higher (OR: 6.46).

Conclusion: New DMTs seem to ease patients’ ability to comply with drug therapy. However, there is a cost of altering treatments as patients switching therapies seem more vulnerable in maintaining persistence. Our results provide options for management. By monitoring prescription fills, pharmacies have the potential to identify potential low adherers upon new product entry.