Patients with favorable prognostic profiles or relapsing-remitting MS are the least likely to initiate high-efficacy disease-modifying therapies recommended by their physician, with many patients citing access challenges.
Virginia Schobel, MSc
Patients with multiple sclerosis (MS) who have favorable prognostic profiles or relapsing-remitting MS, and thus the widest selection of therapeutic options, are less likely to initiate physician-recommended high-efficacy disease-modifying therapy (DMT), new survey data has shown. This is mostly due to market access challenges, the data suggested.
Data from an online survey of 213 US-based neurologists and cross-sectional retrospective chart reviews of 1059 of their patients with MS who initiated their first DMT within 3 months revealed that 49% of physicians preferred to utilize an aggressive, high-efficacy DMT approach to MS. In total, patients with favorable long-term prognosis (n = 103), defined as a lack of concerning risk factors, were less likely (69% vs 83%) to initiate high-efficacy therapy than those with unfavorable long-term prognosis (n = 83; P <.05).
In total, 935 of the initial DMT selections were personally managed by the surveyed neurologists. Led by Virginia Schobel, MSc, franchise head of Neurology, Spherix Global Insights, the investigators wrote that “patient refusal, a more common barrier to adoption of moderate-efficacy DMT recommendations, may be impeding expanded prescribing of oral DMTs among treatment-naive patients.”
The data were presented in a poster at the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), May 28-June 1, in Seattle, Washington.
Of the 46 patients who did not initiate the top recommended DMT as a first-line treatment, 41% did so due to refusal or preference for another therapy. Of that group, 41% cited tolerability concerns, and 37% reported safety concerns outside of the risk for progressive multifocal leukoencephalopathy (PML). The remaining 59% of patients did not initiate the recommended DMT due to insurance formality or denial.
Likewise, of those recommended a standard-efficacy DMT (n = 96) or a moderate-efficacy DMT (n = 63), 33% and 59% (P <.05) of patients, respectively, refused their recommendation, and a respective 67% (P <.05) and 40% experienced insurance formality issues or denial. Additionally, 1% of those recommended standard-efficacy DMTs and 3% of those recommended moderate-efficacy DMTs cited other reasons.
“Among patients who initiated a DMT other than the recommended therapy, market access, nonadherence perceptions, manufacturer support, and comorbidities were more influential in the selection of the current first-line DMT,” Schobel and colleagues wrote.
As for 3-year trends for patients with relapsing-remitting MS, the majority of first-line DMTs were oral (38% in Q1 2017; 41% in Q1 2018; 41% in Q1 2019), with monoclonal antibodies following behind (7% in Q1 2017; 11% in Q1 2018; 10% in Q1 2019). In total, 777 patients, 801 patients, and 758 patients, respectively, were audited in Q1 2017, Q1 2018, and Q1 2019.
Branded glatiramer acetate (16.5%), dimethyl fumarate (16.3%), or ocrelizumab (12.3%) were most likely to be the top recommended DMTs for the optimal treatment among treatment-naive patients. The initiation rate of DMT was highest with oral DMTS (81%), including teriflunomide, fingolimod, and dimethyl fumarate; followed by glatiramer acetate agents (79%); monoclonal antibodies (75%) such as alemtuzumab, ocrelizumab, rituximab, and natalizumab; and interferons (73%), such as interferon beta-1a, peginterferon beta-1a, and interferon beta-1b.
The survey revealed that 730 patients did initiate their top DMT and 205 did not. The initiation rate of the top recommended high-efficacy DMT for those with relapsing-remitting MS (n = 91) was 67%, 68% for those with active secondary progressive MS (n = 34), and 92% for those with primary progressive MS (n = 52) (P <.05).
“With an increasing number of high-efficacy DMTs available, the role of the patient in driving or impeding a shift towards increased adoption of an early aggressive treatment approach is important to understand,” Schobel and colleagues concluded.
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Schobel Vr, Robinson J. First-Line Therapy Selection: How Do Multiple Sclerosis Patients Influence Adoption of U.S. Neurologists’ High-Efficacy Therapy Recommendations? Presented at: 2019 CMSC Annual Meeting. May 28-June 1, 2019; Seattle, WA.