Oral route of medication most preferred for initiating treatment of multiple sclerosis: JAMA

USA: A recent study, published in JAMA Neurology describes substantial shift in disease-modifying therapy prescribing patterns (for multiple sclerosis) over the 20-year period. 

According to the researchers, multiple factors may have contributed to the increasing use of oral therapies, including insurance restrictions, convenience, or direct-to-consumer advertising.

"The majority of individuals with multiple sclerosis (MS) treat the chronic and progressive neurological disorder with oral medications, likely because of many factors, including convenience, consumer advertising and approval by health insurers," the researchers wrote. 

“While two injectable therapies known as platform injectables, were once the mainstay of multiple sclerosis treatment, our study showed oral therapies became the predominate treatment for multiple sclerosis by 2020,” said Mackenzie Henderson, a postdoctoral researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research (IFH) and the lead author of the study. “Our investigation offers an important step in understanding the evolving treatment landscape for MS among U.S. adults and children.”

The study examined a large and diverse sample of commercially insured adults and children in the United States to evaluate trends in uptake of therapies between 2001 and 2020 for patients with MS, a chronic and progressive neurological disorder and the leading cause of nontraumatic disability among young and middle-aged adults.

In 2000, there were two medications approved for MS treatment in the U.S., but over the past 20 years, more than 10 new medications have been approved, according to researchers.

Research on how these approvals have changed clinical practice has been limited. The Rutgers study shows injectable therapies accounted for nearly 100 percent of medications for MS patients in 2001, but by 2020 that decreased to about 25 percent, with oral therapies rising sharply after their introduction in 2010.

Using commercial claims data from more than 100,000 patients with MS between 2001 and 2020, researchers analyzed injectable, infusion and oral treatment trends. They found that oral medications increased sharply in popularity to become the preferable treatment for MS patients over infusion and injectable treatments. Infusion therapies remained low in uptake, accounting for about 8 percent of therapy initiations in 2020, and platform injectable therapy use declined almost 74 percent throughout the study period, according to researchers.

"Despite the availability and efficacy of infusion therapies for multiple sclerosis, we found that their utilization remained relatively low throughout the study period,” said Chintan Dave, a faculty member at the Center for Pharmacoepidemiology and Treatment Science (PETS) at IFH, an assistant professor with Rutgers Ernest Mario School of Pharmacy and a senior author of the study. “This may be due to several factors contributing to this treatment decision by patients and clinicians, including the preference for more convenient oral therapies, the relatively recent introduction of infusion options, and considerations of safety and cost.”

Researchers said this investigation offers a crucial step in understanding the evolving treatment landscape for MS patients and future research should evaluate the impact of new therapies as they emerge.

Reference:

Henderson M, Horton DB, Bhise V, Pal G, Bushnell G, Dave CV. Initiation Patterns of Disease-Modifying Therapies for Multiple Sclerosis Among US Adults and Children, 2001 Through 2020. JAMA Neurol. Published online July 10, 2023. doi:10.1001/jamaneurol.2023.2125