4CPS-109 Persistence evaluation of second-line treatment for multiple sclerosis

<h3>Background and Importance</h3> Second-line treatments manage active relapsing-remitting multiple sclerosis (RRMS) when it persists despite prior disease-modifying therapy or worsens rapidly. <h3>Aim and Objectives</h3> To evaluate and compare treatment persistence with Fingolimod, Natalizumab, and Ocrelizumab in patients diagnosed with RRMS. <h3>Material and Methods</h3> A retrospective observational study was conducted at a referral hospital managing 190 patients with multiple sclerosis. Patients diagnosed with RRMS who started treatment with fingolimod, natalizumab, or ocrelizumab after prior disease-modifying therapies between November-2007 and December-2023 were included. Variables collected included demographics (age, sex) and pharmacotherapeutics (previous treatment, start date, discontinuation date, and reasons for withdrawal). Data were collected using the electronic prescription system (SAVAC) and medical record system (Selene). Categorical variables are presented as percentages (%, N), and continuous variables as median [interquartile range, IQR]. Drug persistence was analysed with the Kaplan-Meier method, and survival across treatments was compared using log-rank test. A p-value &lt;0.05 was considered statistically significant. Statistical analyses were performed using SPSS-Statistics version 23.0. <h3>Results</h3> A total of 95 patients were included, with 65.3% (62) being women and a median age of 40 years [IQR:20]. Treatment distribution was as follows: fingolimod (54.7%,52), ocrelizumab (23.2%,22), and natalizumab (22.1%,21). Previous treatments included glatiramer acetate (32.6%,31), interferon beta-1a (16.8%,16), natalizumab (14.7%,14), teriflunomide (13.6%,13), fingolimod (11.5%,11), dimethyl fumarate (5.2%,5), interferon beta-1b (3.1%,3), and alemtuzumab (2.1%,2). During follow-up, 52.6%(50) discontinued therapy: 68%(34) on fingolimod (16 adverse effects, 15 inefficacy, 3 unknown); 28%(14) on natalizumab (2 adverse effects, 2 inefficacy, 10 due to anti-JCV positive); and 4%(2) on ocrelizumab due to adverse effects. Median persistence was 97.1 months (95% CI:90.5–103.8) for fingolimod and 131.5 months (95% CI:77.8–185.2) for natalizumab, with significant differences (p&lt;0.017). Ocrelizumab had a mean persistence of 39.7 months (95% CI:34.8–41.5), with the median time to discontinuation not reached. Comparing all three drugs revealed significant differences in persistence (p&lt;0.004). <h3>Conclusion and Relevance</h3> About 50% of patients continued treatment, with natalizumab showing greater persistence than fingolimod, which had high discontinuation rates due to adverse effects and inefficacy. Ocrelizumab’s median persistence is undetermined, emphasising the need for long-term studies. With new RRMS therapies emerging, real-world comparisons of effectiveness and persistence are crucial for clinical decision making. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest