Conference Coverage
ORLANDO—Patients with multiple sclerosis (MS) and their physicians still consider self-injected immunomodulating medications as first-line agents, according to the results of a study presented at the ACTRIMS 2017 Forum. The results, based on data from a community health–based suburban neurology practice, also indicated that a smaller percentage than expected of patients on injectable medications switched to an oral medication, and a majority of untreated patients at the initial visit chose to start a self-injectable medication if they started anything.
There are currently 14 FDA-approved immunomodulating medications available for MS and one currently awaiting approval. “This has resulted in patients, in consultation with physicians, having the opportunity to switch from medications that are self injected to medications taken orally or by IV infusion,” said Susan M. Rubin, MD, and colleagues from the Department of Neurology at NorthShore University HealthSystem in Evanston, Illinois. “We speculated that this would result in a high level of treatment changes away from self-injected treatments to the newer options,” Dr. Rubin and colleagues said.
Susan M. Rubin, MD
They optimized their electronic medical record by building structured clinical documentation support (SCDS) tools specific to MS practice that standardize initial and annual follow-up visits, write progress notes, and capture data. The toolkit they built documents immunomodulating medications taken, tracks efficacy and adverse events, and notes reasons for discontinuation.
Patients with MS who were referred to the Department of Neurology at NorthShore University HealthSystem were evaluated at initial and annual follow-up visits using SCDS tools by one of three subspecialty neurologists. The researchers created descriptive reports of their cohort, including gender, age at disease onset, disease duration, use of immunomodulating medications, and Expanded Disability Status Scale scores. Patient-reported treatments at their initial visit were compared with treatments at their first annual follow-up visit.
Of the 105 patients in the study, 78% were female. Disease duration was zero to 43 years, with a mean duration of six years. Nearly three-quarters (74%) were not on an immunomodulating medication at first visit. Of those on medication at first visit, 77% were taking an injectable medication. At the annual follow-up visit, 51% started or changed medication, and 49% remained on the same medication. Of the patients who started treatment, 65% started a self-injection medication, 26% started an oral medication, and 9% started an infusion agent.
“Despite the availability of new treatments,” the researchers said, “patients and their physicians were generally content with the current treatment.” They hypothesized that safety concerns reduced the likelihood of change. “It appears that both patients and physicians prioritized safety over possibly greater efficacy when switching medication.”
—Glenn S. Williams
