A referral to a neurologist may be a mitigating factor for expanded treatment with medication among patients with MS.
AMSTERDAM—About half of insured patients with multiple sclerosis (MS) in the United States do not take disease-modifying drugs within four years of diagnosis, according to a study presented at the Fifth Joint Triennial Congress of the European and Americas Committees for Treatment and Research in MS.
Comorbid conditions, such as depression and inflammatory arthritis, may influence patients’ decision not to use medication. Consultation with a neurologist, however, was associated with expanded use of therapeutic drugs, which increased yearly, according to the study.
The reasons that so many patients with MS do not take medication are unclear. “Some of these patients had not seen a neurologist. Some had forms of MS where there is no treatment. Others have mild MS and preferred no treatment,” Lawrence Steinman, MD, Professor of Neurology and Neurological Sciences at the Stanford University School of Medicine in Palo Alto, California, told Neurology Reviews. “These are just speculative comments,” he added.
Although the benefits of pharmaceutical treatments for MS have been established, it is uncertain which patient populations are more likely to take disease-modifying drugs. A group led by Dr. Steinman studied insurance claims to determine the patient characteristics associated with use of therapeutic drugs.
Using insurance claims made between January 1, 2005, and December 31, 2007, the researchers created a cohort of 32,083 patients with MS, each of whom had had six months of continuous insurance coverage before filling his or her first prescription. The patients’ mean age was roughly 45, and about 75% of patients were female. The team excluded from the study patients first dispensed with immunosuppressants or other medicines.
Among patients treated with a drug, 9,541 first used interferon agents, and 5,212 began by using glatiramer acetate. During the six-month baseline period, the mean age of the treated patients was 45. The cohort included 16,434 patients who used no therapy during the observation period. The mean age of untreated patients during the six-month baseline period was 46.
A greater proportion (ie, 56%) of treated patients than nontreated patients (ie, 37%) was employed full time. Between 0.8% and 1.3% of treated patients filed a long-term disability claim, compared with 0.6% of the nontreated group. About 55% of treated patients visited a neurologist, compared with 46% of nontreated patients.
Dr. Steinman and his colleagues predicted patients’ use of interferon agents or glatiramer acetate in a logistic regression using patients’ baseline variables (eg, age, gender, comorbidities, and geographic region).
A greater proportion of patients in the northeast (ie, 53%) used disease-modifying drugs than in any other region of the US. The south had the lowest percentage of treated patients (ie, 45%). Patients who previously had used interferon or glatiramer acetate were much more likely to use a drug than patients who had not, according to the study.
—Erik Greb