Disease Modifying Agents Use and Associated Outcomes in Multiple Sclerosis

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dc.contributor.advisorAparasu, Rajender R.
dc.contributor.committeeMemberHutton, George J.
dc.contributor.committeeMemberChen, Hua
dc.contributor.committeeMemberJohnson, Michael L.
dc.contributor.committeeMemberThornton, J. Douglas
dc.creatorEarla, Jagadeswara Rao
dc.creator.orcid0000-0002-6688-5273
dc.date.accessioned2021-04-08T21:54:54Z
dc.date.createdAugust 2020
dc.date.issued2020-08
dc.date.submittedAugust 2020
dc.date.updated2021-04-08T21:54:54Z
dc.description.abstractObjective: The specific aims of the study were to (i) determine the factors associated with selection of oral fingolimod versus injectable DMA; (ii) compare the adherence trajectories between oral fingolimod and injectable DMA users; and (iii) assess the comparative effectiveness (relapse /DMA treatment switch) between oral fingolimod and injectable DMA users. Methods: This study will involve a cohort of adult (≥18 years) patients diagnosed with MS and were newly initiated with DMAs identified using 2010-2012 IBM MarketScan commercial claims and encounters database. The main statistical analytical plan involved building three separate multivariate models aligned with the above-stated three aims – (i) a logistic regression model to identify factors associated with selection oral fingolimod, (ii) a IPTW (inverse probability treatment weighted)- multinomial logistic regression model to compare the adherence trajectories, and (iii) a IPTW- Cox proportional hazards regression model to compare the time to relapse/DMA treatment switch between oral and injectable DMA users. Results: The multivariable logistic regression revealed that the likelihood of prescribing oral DMA increased by 2-3 fold during 2011 and 2012 compared to 2010. Patients with ophthalmic issues (adjusted odds ratio [aOR]-2.60) and heart diseases (aOR-2.16) were more likely to receive fingolimod. Use of symptomatic medication (for impaired walking [aOR-2.62], bladder dysfunction [aOR-1.53], and analgesics [aOR-1.50) and neurologist consultation (aOR-1.83) increased the odds of receiving fingolimod. The multinomial regression model with stabilized IPTW revealed that fingolimod users had higher odds to be a complete adherer (aOR: 2.78, 95% CI: 1.85-4.16) or a slow discontinuer (aOR: 2.62, 95% CI: 1.70-1.05) relative to injectable DMA users. The Cox PH regression model with stabilized IPTW revealed that fingolimod users were at lesser risk (adjusted Hazards Ratio [aHR]-0.67, 95% CI: 0.51-0.87) of experiencing the composite endpoint (relapse/DMA treatment switch) than injectable DMA users. Conclusions: During the initial years after market approval (2010-2012), nearly one in seven MS patients initiated treatment with oral fingolimod. Patients with highly active form of MS are more likely to be initiated with oral fingolimod. Oral fingolimod users were associated with better adherence trajectories and lesser risk of having the composite endpoint compared to injectable DMAs.
dc.description.departmentPharmaceutical Health Outcomes and Policy, Department of
dc.format.digitalOriginborn digital
dc.format.mimetypeapplication/pdf
dc.identifier.citationPortions of this document appear in: Earla, J. R., G. J. Hutton, J. D. Thornton, H. Chen, M. L. Johnson, and R. Aparasu. "PND71 FACTORS ASSOCIATED WITH PRESCRIBING OF ORAL FINGOLIMOD IN MULTIPLE SCLEROSIS." Value in Health 23 (2020): S272.; Earla, J. R., G. J. Hutton, J. D. Thornton, H. Chen, M. L. Johnson, and R. Aparasu. "PND104 COMPARATIVE ADHERENCE TRAJECTORIES OF ORAL FINGOLIMOD AND INJECTABLE DISEASE MODIFYING AGENTS IN MULTIPLE SCLEROSIS." Value in Health 23 (2020): S279.
dc.identifier.urihttps://hdl.handle.net/10657/7734
dc.language.isoeng
dc.rightsThe author of this work is the copyright owner. UH Libraries and the Texas Digital Library have their permission to store and provide access to this work. UH Libraries has secured permission to reproduce any and all previously published materials contained in the work. Further transmission, reproduction, or presentation of this work is prohibited except with permission of the author(s).
dc.subjectMultiple sclerosis, Disease modifying agent (DMA), Fingolimod, Oral DMA, Injectable DMA, Factors, Group based trajectory modelling (GBTM), Adherence trajectory, Composite endpoint, Relapse, Switching.
dc.titleDisease Modifying Agents Use and Associated Outcomes in Multiple Sclerosis
dc.type.dcmiText
dc.type.genreThesis
local.embargo.lift2022-08-01
local.embargo.terms2022-08-01
thesis.degree.collegeCollege of Pharmacy
thesis.degree.departmentPharmaceutical Health Outcomes and Policy, Department of
thesis.degree.disciplinePharmaceutic Health Outcomes & Policy
thesis.degree.grantorUniversity of Houston
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Philosophy

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