Background and purposeTreatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real‐world rates of persistence on disease‐modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation.MethodsTreatment data on 4366 consecutive people with relapse‐onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan–Meier survival analyses were used to express DMT persistence.ResultsIn 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1–4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate.ConclusionsImmune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.

中文翻译：

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多发性硬化症疾病缓解疗法在现实世界中的持续性

背景和目的治疗持续性是指随着时间的推移治疗的持续性。它反映了治疗效果和耐受性的结合。我们的目的是描述现实世界中多发性硬化症 (pwMS) 患者坚持疾病缓解疗法 (DMT) 的比率以及 DMT 停用的原因。方法汇集了 4366 名连续复发型多发性硬化症 (MS) 患者的治疗数据2021 年期间有 13 个英国专科中心。纳入标准是至少接触过一种 MS DMT 并具有完整的 DMT 处方历史。盲法临床试验中的 PwMS 被排除在外。收集的数据包括性别、多发性硬化症发病年龄、开始 DMT 时的年龄、DMT 治疗日期以及停止或转换 DMT 的原因。对于接受免疫重建疗法（克拉屈滨/阿仑单抗）的 pwMS，停药日期定义为开始替代 DMT。 Kaplan-Meier 生存分析用于表达 DMT 持久性。结果 在 6997 例治疗事件中（每名 MS 患者 1.6 例），任何单次维持 DMT 花费的中位时间为 4.3 年（95% 置信区间 = 4.1-4.5 年）。停止 DMT 的最常见原因是不良事件 (35.0%) 和缺乏疗效 (30.3%)。 10 年后，接受阿仑单抗治疗的患者中，有 20% 接受了另一次后续 DMT，而接受干扰素或醋酸格拉替雷治疗的患者中，这一比例为 82%。 结论 免疫重建 DMT 可能最有可能为复发性多发性硬化症提供单一治疗。 DMT 持续性和停药原因的比较数据对于指导治疗决策和 MS 的个性化治疗很有价值。