Study tracks adherence to MS therapies in pregnant women, impact on hospitalizations

Women with MS who continue their disease-modifying therapy, or DMT, throughout pregnancy have lower hospitalization costs and use, compared to those who discontinued their therapy.

That finding comes from a retrospective study conducted by Walgreens in collaboration with AllianceRx Walgreens Prime to understand how non-adherence to these women’s DMTs would impact healthcare cost and utilization over a two-year period. The researchers presented the findings on Feb. 26 at the virtual Americas Committee for Treatment and Research in Multiple Sclerosis Forum 2021.

MS is a chronic condition affecting the central nervous system that affects roughly 2.3 million people worldwide, with women affected two to three times as often as men. According to the National MS Society, none of the DMTs are approved for use during pregnancy yet discontinuing DMTs may cause relapse of disease. However, for certain DMTs, studies do indicate that some patients continue their DMT if advised by their healthcare provider.

Kathleen Love, clinical program manager at AllianceRx Walgreens Prime, and an author of the study, said that pregnancy among MS patients make up a significant patient population. “When it comes to pregnancy or thinking of becoming pregnant, a key discussion on the risks and benefits of DMT therapy must take place between the patient and provider.”

As background, the researchers demonstrated in a previous study that adherence among MS patients to DMT medications can reduce both hospitalization events and related costs, by use of measurement methods approved by the Pharmacy Quality Alliance, said Francis Staskon, senior analyst, health analytics, research and reporting at Walgreens, and lead author of both studies.

Heather Kirkham, Walgreens director of health analytics, research and reporting, and a study author, said the broader study looked at all MS patients, not just pregnant MS patients. “We examined the experience of MS patients not specific to pregnancy and their healthcare utilization and total healthcare cost. We decided to look at this subset of patients because they might have a different experience. In the broader study, we did see a relationship between patients who are more adherent having a lower total healthcare cost.”

Using Market Scan commercial claims data over a three-year period (2014-2017), researchers identified MS-diagnosed females and followed their pattern of treatment from outpatient and inpatient visits, as well as DMT pharmaceutical therapy, over two consecutive years.

Researchers created cohorts for those who received pregnancy services in the first year or second year of follow-up, according to their DMT utilization. Using a DMT medication adherence metric, researchers identified patients as adherent to DMT in just one of the years or for both years. “This was a retrospective observational study, with levels of patient DMT adherence segmented into number of years adherent or not, with outcomes on total adjusted medical costs (inpatient or outpatient non-maternity services), DMT costs and associated MS medication costs,” said Staskon.

Of the females who utilized maternity services, 82.7% were in the first-year follow-up period. Of the 500 first-year pregnancies, 79% discontinued DMT utilization into their second year. Analysis on 603 patients DMT utilization found 9.2% adherent in both years, 39.9% adherent in one year and 53.9% of patients were non-adherent in both years. Comorbidities were present among 48 patients, (e.g., diabetes or chronic pulmonary disease). Patients who were consistently adherent had significantly lower adjusted medical costs compared with consistently non-adherent patients or those with mixed adherence.

According to Staskon, the study concluded that pregnant MS patients typically reduce their DMT medication adherence, but a significant number continue, and even demonstrate good adherence levels (PDC ≥.80). Average non-maternity medical costs for adherent patients was significantly lower compared to other two DMT non-adherent or discontinued patient groups. 

“MS is so unpredictable and unique per individual. There are so many choices now for patients with MS, and a very key component in therapy along the continuum of their life is their discussion about their DMT with their prescriber,” said Love. 

Kirkham pointed out that the study validates the importance of clinical interventions such as those AllianceRx Walgreens Prime and Walgreens have within their clinical management programs that support adherence, side effect management, symptom management, and what additional counseling or info that could be added. “This study is very dynamic when you consider the individuality of each patient and her needs. It validates where we are and possibilities of where we can go,” she said.