Is MS Therapy Underutilized?

Early and aggressive therapy for the treatment of multiple sclerosis (MS) has been available in the form of six different ­FDA-approved immunomodulatory agents (IMAs) since 1993. However, results from a recent study have ­revealed that the clinicians who frequently diagnose and treat patients with MS are not consistently prescribing the drugs, despite proof of effectiveness in clinical trials.

“When we looked at patients who are being seen by family practitioners and by neurologists, we were surprised at the number of people who are not benefiting from drugs proven to help reduce the side effects of MS,” according to co-investigator Cormac O’Donovan, MD, Assistant Professor in the Department of Neurology at the Wake Forest University School of Medicine in Winston-Salem. Using data from the National Ambulatory Medical Care Survey (NAMCS), a data bank of detailed information on individual outpatient office visits that is weighted to reflect national estimates, Dr. O’Donovan and colleagues reported in the April 5 online BMC Medicine that 62% of MS patients treated by neurologists and 92% of MS patients treated by family medicine practitioners or internists were not receiving treatment with IMAs.

The researchers reported that there were approximately 6.7 million MS patient visits between 1998 and 2004, at a rate of 3.4 visits per 1,000 persons annually. More than half of all recorded MS patient visits were with neurologists, and one third were with general/family practice physicians and internists. The rate of IMA prescribing by neurologists was substantially greater than that by generalists or internists (21% vs 8%, respectively). “[The difference] prob­­ably reflects greater awareness of the drugs’ availability and their use by specialists who more often treat patients with MS,” stated the authors. MS patients in metropolitan areas were also much more likely to visit neurologists, possibly due to better access to specialty care, which in turn may increase their likelihood of receiving treatment with IMAs. However, despite approval of the first interferon drug five years before the study began, IMA use did not  significantly increase or decrease over the six years examined in the study, and the authors noted that the proportion of established MS patients not receiving IMAs was significant.

In addition, the likelihood of IMA prescription fluctuated for certain MS patient groups: Those ages 40 to 59 were less likely to receive IMA treatment when compared to patients in the 20-to-30 age-group (odds ratio [OR], 0.40), as were patients on Medicaid when compared with those who had private insurance (OR 0.34). In addition, it was found that women more likely than men to take IMAs (OR, 1.98).

Differences in the clinical trials for the medications might make it difficult to compare the treatments directly. However, there are published studies with results that demonstrate a clear benefit of IMAs for decreasing relapses and probability of sustained clinical disability progression in MS patients, including a study published in 2000 by Weinstock-Guttman and Jacobs that proclaimed the benefit of these therapies, especially the interferon beta medications, on MS relapses and progression.           

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