Contributions
Abstract: EP1812
Type: ePoster
Abstract Category: Therapy - symptomatic - 33 Treatment of specific symptoms
Background: In healthcare claims databases, corticosteroid use in MS patients likely indicates relapse. Failure to initiate or switch disease-modifying therapy (DMT) after relapse activity could indicate clinical inertia, in which patients may not be provided individually optimised treatment.
Goal: To assess the presence and impact of clinical inertia in MS patients receiving corticosteroid treatment.
Methods: This analysis included patients with a corticosteroid claim (as a proxy for relapse) during the 12 months prior to the most recent claim with a diagnosis of MS. Treatment patterns were assessed based on medical and pharmacy claims.
Results: 3972 MS patients (n=3304 covered by Medicare [MC] and n=668 covered by commercial [CM] insurance) had ≥1 claim for corticosteroids during the study period; 50% (MC) and 44% (CM) of patients received a steroid as outpatients. Among patients who were on DMT before the initial steroid treatment (n=1517 MC; n=377 CM), DMT claims after steroid were infrequent (10% MC, 16% CM). Of those who did receive DMT, the majority did so ≤60 days post-steroid. 67% (MC) and 68% (CM) of patients had a follow-up physician visit ≤30 days post-steroid, and 83% and 81% within 60 days; 19% (MC) and 17% (CM) of DMT-treated patients had an MRI ≤60 days post-steroid. Rates of post-steroid DMT switching were low (14%-18%; MC and CM) even in patients with ≥2 episodes of steroid use. In the DMT-treated MC population who switched DMT, IFNB-1a was most often the pre-switch DMT (34% and 27%, respectively, for patients with 1 and ≥2 episodes of steroid use), followed by glatiramer acetate (30% and 27%); patients most often switched to an oral DMT (88% after 1 steroid episode, 82% after ≥2 episodes). Patterns for follow-up care were similar in patients not treated with DMT prior to initial steroid; however, they were more likely than DMT-treated patients to have an ER visit (18% each in MC and CM without DMT vs 15% [MC] and 9% [CM] with DMT) or hospitalisation (11% and 9% without DMT vs 9% and 4% with DMT) ≤60 days after initial steroid. No patients newly initiated DMT ≤60 days after initial steroid.
Conclusion: At the time of steroid treatment, only two-thirds of MS patients were receiving DMT. Although acute relapse care and follow-up were documented, DMT initiation and switch rates were low, which may indicate clinical inertia among treating physicians. Further studies are needed to understand the factors driving these treatment patterns.
Study support: Sanofi
Disclosure:
MS, LH, PI: Employees of Sanofi
AC-T, RD: Employees of Comprehensive Health Insights: A Humana Company
Abstract: EP1812
Type: ePoster
Abstract Category: Therapy - symptomatic - 33 Treatment of specific symptoms
Background: In healthcare claims databases, corticosteroid use in MS patients likely indicates relapse. Failure to initiate or switch disease-modifying therapy (DMT) after relapse activity could indicate clinical inertia, in which patients may not be provided individually optimised treatment.
Goal: To assess the presence and impact of clinical inertia in MS patients receiving corticosteroid treatment.
Methods: This analysis included patients with a corticosteroid claim (as a proxy for relapse) during the 12 months prior to the most recent claim with a diagnosis of MS. Treatment patterns were assessed based on medical and pharmacy claims.
Results: 3972 MS patients (n=3304 covered by Medicare [MC] and n=668 covered by commercial [CM] insurance) had ≥1 claim for corticosteroids during the study period; 50% (MC) and 44% (CM) of patients received a steroid as outpatients. Among patients who were on DMT before the initial steroid treatment (n=1517 MC; n=377 CM), DMT claims after steroid were infrequent (10% MC, 16% CM). Of those who did receive DMT, the majority did so ≤60 days post-steroid. 67% (MC) and 68% (CM) of patients had a follow-up physician visit ≤30 days post-steroid, and 83% and 81% within 60 days; 19% (MC) and 17% (CM) of DMT-treated patients had an MRI ≤60 days post-steroid. Rates of post-steroid DMT switching were low (14%-18%; MC and CM) even in patients with ≥2 episodes of steroid use. In the DMT-treated MC population who switched DMT, IFNB-1a was most often the pre-switch DMT (34% and 27%, respectively, for patients with 1 and ≥2 episodes of steroid use), followed by glatiramer acetate (30% and 27%); patients most often switched to an oral DMT (88% after 1 steroid episode, 82% after ≥2 episodes). Patterns for follow-up care were similar in patients not treated with DMT prior to initial steroid; however, they were more likely than DMT-treated patients to have an ER visit (18% each in MC and CM without DMT vs 15% [MC] and 9% [CM] with DMT) or hospitalisation (11% and 9% without DMT vs 9% and 4% with DMT) ≤60 days after initial steroid. No patients newly initiated DMT ≤60 days after initial steroid.
Conclusion: At the time of steroid treatment, only two-thirds of MS patients were receiving DMT. Although acute relapse care and follow-up were documented, DMT initiation and switch rates were low, which may indicate clinical inertia among treating physicians. Further studies are needed to understand the factors driving these treatment patterns.
Study support: Sanofi
Disclosure:
MS, LH, PI: Employees of Sanofi
AC-T, RD: Employees of Comprehensive Health Insights: A Humana Company