Teriflunomide in the Treatment of RRMS: The Best Working Drug Is the One That the Patient Actually Takes

Teriflunomide in the Treatment of Multiple Sclerosis 

Most patients with multiple sclerosis have a relapsing-remitting form of the disease characterized by alternating attacks (relapses) and remissions. For patients with RRMS, there are a number of disease-modifying drugs available in oral, subcutaneous, or intravenous forms that have been proven to reduce the occurrence of relapses and mitigate other symptoms of the disease. One of these is the oral immunomodulator with anti-inflammatory effects teriflunomide, indicated for the treatment of adults and children over 10 years old with RRMS and taken once daily. Despite its proven efficacy, safety, and simple administration, adherence to this therapy in practice is not optimal. This study therefore focused on evaluating the adherence of patients with RRMS to using teriflunomide based on the number of days covered by treatment, and subsequently the correlation between treatment adherence and the occurrence of relapses and the utilization of healthcare services. 

Study Methodology 

The authors used records from the IQVIA PharMetrics Plus database, which allows the linking of patient data from pharmacies and healthcare facilities. The evaluated population included patients with RRMS aged ≥ 18 years, who newly initiated treatment with teriflunomide in 2018–2019, with medical documentation available 1 year before and 1 year after starting teriflunomide. 

Subjects were then divided according to the proportion of days covered by treatment (PDC) during the first year after the initial prescription of teriflunomide into a high adherence group (PDC ≥ 80%) and a low adherence group (PDC ≤ 50%). PDC was determined based on medication picked up at the pharmacy. Their results were compared using logistic regression. 

Relapses were defined as events requiring hospitalization related to the primary diagnosis of MS or outpatient treatment related to MS and prescription of oral or intravenous corticosteroids within 7 days of an outpatient visit. All models were adjusted for age group, gender, region, baseline status, basic comorbidities, and healthcare utilization before the initial prescription of teriflunomide. 

Results

In the observed population of 922 patients with RRMS newly started on teriflunomide, 534 (57.9%) demonstrated high adherence to the treatment (PDC ≥ 80%) and 249 (27.0%) low adherence (PDC ≤ 50%). The average age was 48.8 years in the high adherence group and 47.5 years in the low adherence group. Both groups were not significantly different in terms of demographic characteristics and comorbidities. Patients with low adherence had more frequent emergency room visits (36.9 vs. 26.8%; p = 0.004) and hospitalizations (17.3 vs. 10.9%; p = 0.013) 1 year before starting teriflunomide.  

During the first year after starting teriflunomide, the high adherence group had a statistically significantly lower occurrence of relapses than the low adherence group (28.5 vs. 42.6%; p < 0.001). The groups did not significantly differ in the occurrence of severe infections and EDSS (Expanded Disability Status Scale) scores. Patients with high adherence to teriflunomide were significantly less frequently treated in the emergency room (17.2 vs. 31.3%) and significantly less frequently hospitalized (4.5 vs. 8.4%; both p < 0.001). 

Even after adjusting for potential confounding factors (including healthcare utilization before starting teriflunomide), high adherence was associated with a lower likelihood of recurrences after starting treatment (27.5 vs. 40.9%; odds ratio [OR] 0.55; 95% confidence interval [CI] 0.39–0.76), emergency room visits (16.0 vs. 28.1%; OR 0.49; 95% CI 0.34–0.71), and hospitalization (3.6 vs. 6.7%; OR 0.51; 95% CI 0.27–0.97). 

Conclusion 

The results of this study confirm the insufficient adherence to RRMS treatment with teriflunomide and also previous findings that high adherence to its use is associated with a significantly lower number of relapses and lesser necessity for healthcare utilization. Patients with at least 80% of days covered by teriflunomide treatment had a 45% lower risk of relapse and a 50% lower risk of emergency room visits or hospitalizations due to RRMS during the 1st year of treatment. Increasing adherence to teriflunomide treatment should therefore overall improve clinical outcomes for patients and reduce the burden on the healthcare system.

(lexi) 

Source: Greene N., Higuchi K., Bognar K. et al. Medication adherence and healthcare utilization in relapsing-remitting multiple sclerosis patients using teriflunomide. Clinicoecon Outcomes Res 2022; 14: 755–761, doi: 10.2147/CEOR.S383934.