The Impact of Changing the Course of Multiple Sclerosis Treatment with First-Line DMT Medications on Hospital Readmission Rate in Taiwan

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Backgrounds Multiple sclerosis (MS) is considered an uncommon and rare disease in Taiwan. MS is a chronic neuroimmunologic disorder and a demyelinating disease of the central nervous system that results in damage to the protective covering of the peripheral nerves (myelin sheath) and causes the loss of myelin (demyelination) due to this repeated inflammatory demyelinating condition. Disease-modifying therapies (DMTs) are a long-term comprehensive care for the treatment of people with MS. Using immunomodulatory agents (immunomodulators) is the main therapeutic strategy for managing the frequency of MS relapses. Objective There are three main disease-modifying drugs (DMDs) used as first-line treatments for MS. They are glatiramer acetate (Copaxone®) and interferon beta preparations, which are divided into interferon β-1a (Rebif®) and interferon β-1b (Betaferon®). The purpose of this study is to analyze and discuss the correlations of the annual MS relapse rate and the changing courses of treatment between three DMDs. Methods This was a multicenter and retrospective study that used MS literature citations as baseline references. This study compared annual MS relapse rate as a primary efficacy endpoint and the usage of the medications in Taiwan. The study determined the impact of the prevalence rate and the consumption of the medical resources between Taiwan and other countries in line with the adoption of specific MS 2007-2009 holistic file data from National Health Insurance Research Database provided by National Health Research Institutes. A comprehensive analysis of the types of medications such as Betaferon®, Copaxone® and Rebif® are also included in this study. Results Part I: The prevalence of people with female MS patients in Taiwan regardless of gender is higher than the prevalence of MS by the world standards. In addition, the Taiwan Ministry of Health and Welfare worked in conjunction with the Taiwan Health Promotion Administration to set a standard definition of rare diseases as the prevalence rate of 1/10,000 or less. The prevalence of women with MS in Taiwan also exceeded the overall Taiwanese standard. Part II: Rebif® had the highest dispensing percentage of all three DMDs. The proportion of prescription drug distribution of Rebif® was 59.75% and its 2007--2009 annual relapse rate calculated according to the annual number of hospitalizations was 1.22 / 1.27 / 1.17. The proportion of prescription drug distribution of Betaferon® was 27.63% and its 2007 - 2009 annual relapse rate calculated according to the annual number of hospitalizations was 1.10 / 1.08 / 1.43. The proportion of prescription drug distribution of Copaxone® was 17.01% and its 2007--2009 annual relapse rate calculated according to the annual number of hospitalizations was 1.66 / 2.12 / 1.75. Part III: The case group (Betaferon®, Copaxone® and Rebif®) and the control group both achieved the statistical difference (P