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Limitations
Claims database analysis allows for estimation of real-world treatment patterns, including persistence with individual therapies, and the strength of our analysis derives from the large, geographically diverse population studied. All retrospective database analyses are subject to certain limitations, and the results of this study must be interpreted with appropriate consideration of these limitations. Claims data are collected primarily for payment purposes, not research, and are subject to coding errors. Presence of a diagnosis code for MS on a medical claim is not positive presence of MS. The presence of a claim for a filled prescription does not necessarily indicate that the medication was consumed or that it was taken as prescribed. Medications filled over-the-counter or provided as samples by the physician were not observed in the claims data, and regimen changes were based on filled prescriptions. Claims-based data are constrained by coverage limitations that determine the data available and limit generalizability of results to managed care patients.
Limitations specific to this study include the inability to ascertain the reasons why patients had a change in regimen. Although claims data do not provide this information, key factors influencing persistence and discontinuation in MS patients in the literature include those mentioned previously. Additionally, the study window of 2001 to 2010 did not allow an investigation of persistence with the new generation of oral therapies for MS.
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