Comparing First-line Natalizumab and Ocrelizumab Use for the Treatment of Multiple Sclerosis: A Komodo Health Claims Database Study
Jeffrey Kaplan1, Dana Beenstock2, Martin Belkin3, Heidi Crayton4, Christopher Eckstein5, Ruth Fredericks6, Boyang Bian7, Nicholas Belviso7, Daphne Ni7, Danette Rutledge7
1Kansas City MS Center, 2Linda E. Cardinale Multiple Sclerosis Center, 3Michigan Institute for Neurological Disorders, 4MS Center of Greater Washington, 5Department of Neuroimmunology and MS, Duke University, 6St. Dominic Neuroscience Center, 7Biogen
Objective:
To compare the difference of post-treatment initiation relapse outcomes as well as non-disease-modifying therapy (DMT) healthcare resource utilization (HCRU) and healthcare costs (HCC), in patients with multiple sclerosis (MS) who were treated with first-line natalizumab (NTZ, TYSABRI®) or ocrelizumab (OCR).
Background:
MS relapses contribute to disability accumulation which impacts HCRU and HCC. Early use of high-efficacy DMTs like NTZ and OCR in newly-diagnosed MS patients have been shown to improve clinical outcomes. More studies comparing NTZ and OCR as first-line treatments are needed.
Design/Methods:
This retrospective observational study utilized data from a US healthcare claims database. Eligible patients were aged 18-64, newly diagnosed with MS between January 1, 2017 and March 31, 2022, and began first-line treatment with either NTZ or OCR ≤2 years of the initial MS diagnosis claim. Propensity score matching of NTZ and OCR cohorts was performed (1:2 ratio). Outcomes included annualized relapse rate (ARR) and non-DMT HCRU and HCC (inpatient [IP] admissions, emergency department [ED] and outpatient visits) estimated by generalized linear models.
Results:
After matching, 1261 NTZ and 2522 OCR patients were included. NTZ patients, versus OCR patients, had significantly lower ARR (mean 0.2 vs. 0.28, p<0.001), all-cause and MS-related non-DMT IP admissions (mean 0.06 vs. 0.09 admissions per person per year [PPPY], p=0.003; 0.05 vs. 0.08 PPPY, p=0.002) and ED visits (mean 0.39 vs. 0.48 PPPY, p=0.015; 0.17 vs. 0.22 PPPY, p=0.013), as well as all-cause and MS-related non-DMT IP associated costs (mean $15,924 vs. $23,124 PPPY, p=0.011; mean $15,623 vs. $22,317 PPPY, p=0.023).
Conclusions:
First-line NTZ was associated with significantly lower ARR, IP and ED HCRU, and IP HCC versus first-line OCR. With the increasing use of high-efficacy therapies early in the disease course, this study adds to the evidence that NTZ is a clinically and cost effective first-line therapy for newly diagnosed MS patients.
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