A retrospective claims analysis: Compliance and discontinuation rates among Canadian patients with multiple sclerosis treated with disease-modifying therapies

PLoS One. 2019 Jan 14;14(1):e0210417. doi: 10.1371/journal.pone.0210417. eCollection 2019.


Background: Compliance to disease modifying therapy (DMT) is associated with a reduced risk of relapse, lower healthcare resource utilization, and improved health-related quality of life in patients with multiple sclerosis (MS). Our objective was to assess the compliance and discontinuation rates of fingolimod relative to other oral, injectable, and infusible DMTs available on the market at the time of the study in Canada in patients with relapsing-remitting MS (RRMS).

Methods and findings: We conducted a retrospective claims analysis. Patients with RRMS with ≥ 1 prescription for each DMT were included. Compliance (medication possession ratio of ≥ 80%) and discontinuation (gap > 30 days from the end of the index prescription) were calculated at the 6-, 12- and 24-month time points. Compliance with fingolimod at the 6-, 12- and 24-month time points was 75%, 75% and 70%, respectively; compared with DMF [70% (P < 0.001), 68% (P < 0.001), and 56% (P < 0.001), respectively], and BRACE [53% (P < 0.001), 47% (P < 0.001), and 35% (P < 0.001), respectively]. Compliance with fingolimod was comparable to teriflunomide at each time point, but was higher compared to natalizumab [70% versus 57% (P < 0.001)] at the 24-month time point. At the 6-, 12- and 24-month time points, patients on fingolimod had the lowest discontinuation rate (26%, 24%, and 29%, respectively) compared to BRACE [49% (P < 0.001), 44% (P < 0.001), and 57% (P < 0.001)], respectively], and natalizumab [33% (P < 0.001), 29% (P < 0.001), and 45% (P < 0.001), respectively], and was similar to teriflunomide (26%, 25%, and 31%, respectively).

Conclusions: The compliance rate in fingolimod treated patients at the 24 month time point was higher than that observed in natalizumab treated patients. The discontinuation rate was lower with fingolimod compared to other DMTs at all time points but was similar to teriflunomide.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Crotonates / therapeutic use
  • Dimethyl Fumarate / therapeutic use
  • Fingolimod Hydrochloride / therapeutic use*
  • Humans
  • Hydroxybutyrates
  • Immunosuppressive Agents / therapeutic use*
  • Insurance Claim Review
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Natalizumab / therapeutic use
  • Nitriles
  • Patient Compliance
  • Retrospective Studies
  • Toluidines / therapeutic use


  • Crotonates
  • Hydroxybutyrates
  • Immunosuppressive Agents
  • Natalizumab
  • Nitriles
  • Toluidines
  • teriflunomide
  • Dimethyl Fumarate
  • Fingolimod Hydrochloride

Grants and funding

This research was funded by Novartis Pharmaceuticals Canada Inc. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Soukaina Mouallif, Hamid Reza Nakhaipour, Paola Haddad, and Robyn Schecter are employees of Novartis Pharmaceuticals Canada Inc. The specific roles of these authors are articulated in the ‘author contributions’ section.