PLoS ONE (Jan 2017)

Sativex in resistant multiple sclerosis spasticity: Discontinuation study in a large population of Italian patients (SA.FE. study).

  • Silvia Messina,
  • Claudio Solaro,
  • Isabella Righini,
  • Roberto Bergamaschi,
  • Simona Bonavita,
  • Roberto Bruno Bossio,
  • Vincenzo Brescia Morra,
  • Gianfranco Costantino,
  • Paola Cavalla,
  • Diego Centonze,
  • Giancarlo Comi,
  • Salvatore Cottone,
  • Maura Chiara Danni,
  • Ada Francia,
  • Alberto Gajofatto,
  • Claudio Gasperini,
  • Mauro Zaffaroni,
  • Loredana Petrucci,
  • Elisabetta Signoriello,
  • Giorgia Teresa Maniscalco,
  • Gabriella Spinicci,
  • Manuela Matta,
  • Massimiliano Mirabella,
  • Graziella Pedà,
  • Letizia Castelli,
  • Marco Rovaris,
  • Edoardo Sessa,
  • Daniele Spitaleri,
  • Damiano Paolicelli,
  • Alfredo Granata,
  • Mario Zappia,
  • Francesco Patti,
  • SA.FE. study group

DOI
https://doi.org/10.1371/journal.pone.0180651
Journal volume & issue
Vol. 12, no. 8
p. e0180651

Abstract

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The approval of Sativex for the management of multiple sclerosis (MS) spasticity opened a new opportunity to many patients. In Italy, the healthcare payer can be fully reimbursed by the involved pharma company with the cost of treatment for patients not responding after a 4 week (28 days) trial period (Payment by Results, PbR), and 50% reimbursed with the cost of 6 weeks (42 days) treatment for other patients discontinuing (Cost Sharing, CS). The aim of our study was to describe the Sativex discontinuation profile from a large population of spasticity treated Italian MS patients.We collected data of patients from 30 MS centres across the country starting Sativex between January 2014 and February 2015. Data were collected from the mandatory Italian Medicines Agency (AIFA) web-registry. Predictors of treatment discontinuation were assessed using a multivariate Cox proportional regression analysis.During the observation period 631 out of 1597 (39.5%) patients discontinued Sativex. The Kaplan-Meier estimates curve showed that 333 patients (20.8%) discontinued treatment at 4 weeks while 422 patients (26.4%) discontinued at 6 weeks. We found after adjusted modeling that a higher NRS score at T1 (adjHR 2.23, 95% 2.07-2.41, p<0.001) and a lower baseline NRS score (adjHR 0.51 95% CI 0.46-0.56, p<0.001) were predictive of treatment discontinuation.These data show that the first 6 weeks are useful in identifying those patients in which Sativex could be effective, thus avoiding the cost of longer term evaluation.