{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T03:39:04Z","timestamp":1784345944874,"version":"3.55.0"},"reference-count":38,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,5,22]],"date-time":"2023-05-22T00:00:00Z","timestamp":1684713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R03HS028502"],"award-info":[{"award-number":["R03HS028502"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Study Objective<\/jats:title><jats:p>This study compared the adherence trajectories of fingolimod (FIN), teriflunomide (TER), and dimethyl fumarate (DMF) users with multiple sclerosis (MS) as there is limited evidence regarding the comparative adherence patterns of different oral disease\u2010modifying agents (DMAs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A retrospective cohort study<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Source<\/jats:title><jats:p>2015\u20132019 IBM MarketScan Commercial Claims Database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Adults (\u226518\u2009years) with MS (International Classification of Diseases [ICD]\u20109\/10\u2010Clinical Modification [CM]:340\/G35) diagnosis and \u22651 DMA prescription.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Incident FIN\u2010, TER\u2010, or DMF use based on the index DMA with 1 year of washout period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The DMA adherence trajectories based on the proportion of days covered (PDC) were examined using the Group\u2010Based Trajectory Modeling (GBTM) one year after the treatment initiation. Generalized boosting models (GBM)\u2010based inverse probability treatment weights (IPTW) were incorporated in multinomial logistic regression to assess the comparative adherence trajectories across oral DMAs with FIN group as a reference category.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>The study cohort consisted of 1913 patients with MS who were initiated with FIN (24.2%, <jats:italic>n<\/jats:italic>\u2009=\u2009462), TER (24.0%, <jats:italic>n<\/jats:italic>\u2009=\u2009458), and DMF (51.9%, <jats:italic>n<\/jats:italic>\u2009=\u2009993) during 2016\u20132018. The adherence rate (PDC\u2009\u2265\u20090.8) among FIN, TER, and DMF users was found to be 70.8% (<jats:italic>n<\/jats:italic>\u2009=\u2009327), 59.6% (<jats:italic>n<\/jats:italic>\u2009=\u2009273), and 61.0% (<jats:italic>n<\/jats:italic>\u2009=\u2009606), respectively. The GBTM grouped patients into three adherence trajectories: Complete Adherers\u201459.1%, Slow Decliners\u201422.6%, and Rapid Discontinuers\u201418.3%. The multinomial logistic regression model involving GBM\u2010based IPTW revealed that DMF (adjusted odds ratio [aOR]: 2.32, 95% confidence interval [CI]:1.57\u20133.42) and TER (aOR: 2.50, 95% CI: 1.62\u20133.88) users had higher odds to be rapid discontinuers relative to FIN users. In addition, TER users were more likely (aOR: 1.50, 95% CI: 1.06\u20132.13) to be slow decliners compared with FIN users.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Teriflunomide and DMF were associated with poorer adherence trajectories than FIN. More research is needed to evaluate the clinical implications of these adherence trajectories of oral DMAs to optimize the management of MS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2810","type":"journal-article","created":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T00:25:26Z","timestamp":1683591926000},"page":"473-484","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative adherence trajectories of oral disease\u2010modifying agents in multiple sclerosis"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6688-5273","authenticated-orcid":false,"given":"Jagadeswara Rao","family":"Earla","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy University of Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieni","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy University of Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George J.","family":"Hutton","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy University of Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2310-901X","authenticated-orcid":false,"given":"Rajender R.","family":"Aparasu","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy University of Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32388-1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2015.03.001"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4081\/ni.2016.6513"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001139"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2020.02.016"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102334"},{"issue":"2","key":"e_1_2_9_8_1","first-page":"74","article-title":"Expenditure, utilization, and cost of specialty drugs for multiple sclerosis in the US Medicaid population, 2008\u20102018","volume":"13","author":"Elsisi Z","year":"2020","journal-title":"Am Health Drug Benefits"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNN.0000000000000395"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2011-038"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/03007995.2017.1374937"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/CEOR.S130334"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2013.19.s1.S24"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2018.12.025"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2016.22.12.1394"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/2055217316677868"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.7556\/jaoa.2017.145"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-13-138"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2014.940422"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S270557"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182984c1f"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3787"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01830-0"},{"key":"e_1_2_9_24_1","volume-title":"The Truven Health MarketScan Databases for Life Sciences Researchers","author":"Hansen L","year":"2017"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007043"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.2307\/2137284"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2018.08.006"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1K671"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H018"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.121208.131413"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1159\/000360229"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/70.1.41"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5753"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000359"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.23.8.844"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-010-0093-7"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2018.09.038"},{"issue":"16","key":"e_1_2_9_39_1","doi-asserted-by":"crossref","first-page":"P2.052","DOI":"10.1212\/WNL.88.16_supplement.P2.052","article-title":"Development of an algorithm to identify multiple sclerosis (MS) disease severity based on healthcare costs in a US administrative claims database (P2.052)","volume":"88","author":"Nicholas J","year":"2017","journal-title":"Neurology"}],"updated-by":[{"DOI":"10.1002\/phar.2846","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T00:00:00Z","timestamp":1692576000000}}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.2810","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:23:21Z","timestamp":1761056601000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.2810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,22]]},"references-count":38,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1002\/phar.2810"],"URL":"https:\/\/doi.org\/10.1002\/phar.2810","archive":["Portico"],"relation":{"correction":[{"id-type":"doi","id":"10.1002\/phar.2846","asserted-by":"object"}]},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,22]]},"assertion":[{"value":"2022-09-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}