MS Treatment Guidelines Are Not Being Followed

Even though American Academy of Neurology guidelines recommend stopping disease modifying therapy (DMT) in older individuals with multiple sclerosis (MS) who do not have ongoing relapses and who are nonambulatory for at least 2 years, new research shows that many practitioners are not following this recommendation.

According to the new study, practitioners had a substantial number of older individuals with non-relapsing MS who were disabled on a DMT in 2000 and in 2009—even after the 2002 guidelines were released. 

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The study, which was co-authored by Dr R. Phillip Kinkel and colleagues, was presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2019.

Using data from the Sonya Slifka Longitudinal Multiple Sclerosis Study, the researchers determined the use of DMT in 2009 among 2361 participants and compared that with the rates among 2156 participants in 2000.

Between 2000 and 2009, DMT use increased from 55.3% to 61.5% overall and from 63.5% to 68.7% among patients with relapsing-remitting MS.

Contrary to the published evidence-based guidelines, DMT use was significant among participants with secondary progressive MS, increasing from 47.2% to 51.5%. And though it  decreased from 36.4% in 2000 to 34.3% in 2009, the use of DMT in primary progressive MS was also significant. 

Because many individuals with MS who were older than 54 years, who had non-relapsing courses, and who had severe disability were on DMTs, “Many patients risk adverse effects and high costs without likelihood of benefit, and the field faces greater constraints on patient and clinician preferences as prices rise and payers intensify efforts to control costs,” the researchers concluded. 

“For individual patients, there may be good reasons to deviate, and these should be fully discussed so patient and clinician can reach a shared decision. More evidence and education are needed to ensure the most appropriate treatments for the right individuals at the right time at the right cost.”

—Colleen Murphy

Reference:

Kinkel R, Minden SL, Troxell RM. Use and cost of disease modifying therapy between 2000 and 2009: are neurologists adhering to treatment guidelines? Paper presented at: Americas Committee for Treatment and Research in Multiple Sclerosis Forum 2019; February 28-March 2, 2019; Dallas, TX. https://actrims.confex.com/actrims/2019/meetingapp.cgi/Paper/4141. Accessed March 15, 2019.