DMT Uptake, Prescriptions Not Fitting Disease Course Among Patients With MS

Patients with multiple sclerosis (MS) who are younger than 60 years are not reaping maximal benefits from disease-modifying treatments (DMTs), as evidenced by their suboptimal prescription uptake, researchers concluded in a study published in Therapeutic Advances in Neurological Disorders.

Real-world data are lacking on DMT prescribing patterns for patients with MS, and the authors proposed that younger patients should be benefiting more from these medicines due to their higher disease activity.

“With increasing age, people with MS are less likely to have clinical relapses or radiological disease activity,” they stated. “As a result, younger people with MS are more likely to derive the most documented or apparent benefits.”

Their study investigated outcomes among US veterans compared with the general population, with 2018 data supplied by North American Research Committee on Multiple Sclerosis (NARCOMS; n = 6948 patients; general population) registry and the US Department of Veterans Affairs Multiple Sclerosis Surveillance Registry (MSSR; n = 1719 patients; veteran population). NARCOMS asks its registrants to update their information every 6 months.

Their investigation revealed the following:

• Fewer than half (47.9%) of NARCOMS respondents reported DMT use, and more than half (52.9%) reported no use when they took the survey.
• DMT use in NARCOMS was lower among older (aged 71-80 years) vs younger (aged 40 or younger) patients: 29.5% vs 61.4%.
• Just over half (54.5%) of MSSR respondents reported current prescriptions for DMTs.
• DMT prescriptions in MSSR were lower among older (aged 71-80 years) vs younger (aged 40 or younger) patients: 27.2% vs 70.5%.
• MSSR contained more younger patients (aged 31-40; P = .035; aged 41-50; P = .001) prescribed DMTs vs NARCOMS: 70.5% and 72.5% vs 61.5% and 62.7%, respectively.

For the remaining age groups (ages 21-30, 51-60, 61-70, 71-80, and 80-plus years), DMT prescriptions patterns were equivalent between the registries.

The authors highlight that their mixed results bear out that more than one-third of younger persons with MS are not using DMTs, “despite widespread recognition of the importance of early treatment in MS,” while conversely, prescriptions for them remain the norm among older patients despite greater chances of adverse effects and diminished disease activity. They attribute this latter finding to belief that “disease inactivity is due to treatment rather than the natural disease course with aging.”

“Further studies are needed to understand and address lack of treatment in young adults with MS,” the authors conclude, “as well as the reasons for persistent DMT use in the elderly.”

These studies should be randomized controlled trials, they added, and rigorous.

Limitations on their findings include that NARCOMS participation is voluntary, which could introduce responder bias compared with persons with MS not taking part in the registry, and a dearth of reasons for prescribing or not prescribing DMTs.

Reference

Zhang Y, Salter A, Jin S, et al. Disease-modifying therapy prescription patterns in people with multiple sclerosis by age. Ther Adv Neurol Disord. Published online March 31, 2021. doi:10.1177/17562864211006499