A multicentRE observational analysiS of PErsistenCe to Treatment in the new multiple sclerosis era: the RESPECT study

作者：Lanzillo Roberta; Prosperini Luca^*; Gasperini Claudio; Moccia Marcello; Fantozzi Roberta; Tortorella Carla; Nociti Viviana; Annovazzi Pietro; Cavalla Paola; Radaelli Marta; Malucchi Simona; Clerici Valentina Torri; Boffa Laura; Buttari Fabio; Ragonese Paolo; Maniscalco Giorgia Teresa; Di Filippo Massimiliano; Buscarinu Maria Chiara; Pinardi Federica; Gallo Antonio; Coghe Giancarlo; Pesci Ilaria; Laroni Alice; Gajofatto Alberto; Calabrese Massimiliano

来源：Journal of Neurology, 2018, 265(5): 1174-1183.

DOI：10.1007/s00415-018-8831-x

• Multiple sclerosis
• Disease-modifying therapies
• Outcome measurement
• Quality of life
• Persistence to treatment

In this independent, multicenter, retrospective study, we investigated the short-term persistence to treatment with first-line self-injectable or oral disease-modifying treatments (DMTs) in patients with relapsing-remitting multiple sclerosis. Data of patients regularly attending 21 Italian MS Centres who started a self-injectable or an oral DMT in 2015 were collected to: (1) estimate the proportion of patients discontinuing the treatment; (3) explore reasons for discontinuation; (3) identify baseline predictors of treatment discontinuation over a follow-up period of 12 months. We analyzed data of 1832 consecutive patients (1289 women, 543 men); 374 (20.4%) of them discontinued the prescribed DMT after a median time of 6 months (range 3 days to 11.5 months) due to poor tolerability (n = 163; 43.6%), disease activity (n = 95; 25.4%), adverse events (n = 64; 17.1%), convenience (i.e. availability of new drug formulations) and pregnancy planning (n = 21; 1.1%). Although the proportion of discontinuers was higher with self-injectable (n = 107; 22.9%) than with oral DMT (n = 215; 16.4%), the Cox regression model revealed no significant between-group difference (p = 0.12). Female sex [hazard ratio (HR) = 1.39, p = 0.01] and previous exposure to 3 DMTs (HR = 1.71, p = 0.009) were two independent risk factors for treatment discontinuation, regardless of prescribed DMTs. Our study confirms that persistence to treatment represents a clinical challenge, irrespective of the route of administration.

• 出版日期2018-5