Contributions
Abstract: P868
Type: Poster Sessions
Abstract Category: Therapy - Immunomodulation/Immunosuppression
American Academy of Neurology guidelines recommend use of more effective multiple sclerosis (MS) therapies for those with a concerning level of disease activity. The frequency of first-line highly effective therapy use in a treatment optimization approach has not been formally assessed.
Evaluate neurologist perceptions and use of high-efficacy therapies as first-line treatment for newly diagnosed relapsing remitting MS (RRMS) patients for treatment optimization, as opposed to a treatment escalation approach.
To understand if neurologists are using a new start treatment optimization approach. We hypothesize that use of highly effective therapies as first-line treatment is increasing over time and is largely driven by academic MS centers.
Between 12/2017-2/2018, 274 U.S. neurologists contributed chart reviews of 801 RRMS patients who initiated their first disease-modifying therapy (DMT) within the previous three months. The prior year 242 neurologists contributed 777 RRMS patient charts. High-efficacy DMTs included fingolimod, alemtuzumab, ocrelizumab, rituximab, natalizumab, and daclizumab.
Compared to the year prior, a similar share of RRMS patients were initiated on a high-efficacy DMT as their first-line therapy (23.3% for 2018 vs. 19.9% for 2017, p=0.10). The slight increase in high-efficacy new start share was largely due to ocrelizumab availability (4.7% vs. 0%) as shares of other high-efficacy DMTs remained stable. 52% of neurologists agreed that, when initiating a patient on DMT therapy, they prefer to use a DMT optimization approach using a high-efficacy agent, as opposed to a therapy escalation approach. High-efficacy selection for new start patients did not differ based upon neurologists' self-reported attitude, with 24.8% of patients initiated on a high-efficacy DMT among those neurologists who agreed with an optimization approach versus 18.9% among those who disagreed (p=0.17). Neurologists newer to clinical practice prescribed high-efficacy DMTs in similar proportions to more experienced practitioners (28.1% 2-9 y post fellowship, 21.1% 10-17 y, 20.8% 18-35 y, p=0.08). First-line use of high-efficacy DMTs did not differ by practice setting, academic affiliation, or MS center affiliation.
While U.S. neurologists report that they prefer an optimization or aggressive approach to MS management, recent DMT initiations among treatment-naive RRMS patients suggest that the traditional escalation approach continues to dominate clinical practice.
Disclosure: Robert T. Naismith consults for Acorda, Alkermes, Biogen, EMD Serono, Genentech, Genzyme, Novartis, Teva.
Jennifer Robinson is the founder of Spherix Global Insights, an independent market intelligence firm and has received no industry funding to conduct and report on this study.
Virginia R. Schobel is an employee of Spherix Global Insights, an independent market intelligence firm and has received no industry funding to conduct and report on this study.
Abstract: P868
Type: Poster Sessions
Abstract Category: Therapy - Immunomodulation/Immunosuppression
American Academy of Neurology guidelines recommend use of more effective multiple sclerosis (MS) therapies for those with a concerning level of disease activity. The frequency of first-line highly effective therapy use in a treatment optimization approach has not been formally assessed.
Evaluate neurologist perceptions and use of high-efficacy therapies as first-line treatment for newly diagnosed relapsing remitting MS (RRMS) patients for treatment optimization, as opposed to a treatment escalation approach.
To understand if neurologists are using a new start treatment optimization approach. We hypothesize that use of highly effective therapies as first-line treatment is increasing over time and is largely driven by academic MS centers.
Between 12/2017-2/2018, 274 U.S. neurologists contributed chart reviews of 801 RRMS patients who initiated their first disease-modifying therapy (DMT) within the previous three months. The prior year 242 neurologists contributed 777 RRMS patient charts. High-efficacy DMTs included fingolimod, alemtuzumab, ocrelizumab, rituximab, natalizumab, and daclizumab.
Compared to the year prior, a similar share of RRMS patients were initiated on a high-efficacy DMT as their first-line therapy (23.3% for 2018 vs. 19.9% for 2017, p=0.10). The slight increase in high-efficacy new start share was largely due to ocrelizumab availability (4.7% vs. 0%) as shares of other high-efficacy DMTs remained stable. 52% of neurologists agreed that, when initiating a patient on DMT therapy, they prefer to use a DMT optimization approach using a high-efficacy agent, as opposed to a therapy escalation approach. High-efficacy selection for new start patients did not differ based upon neurologists' self-reported attitude, with 24.8% of patients initiated on a high-efficacy DMT among those neurologists who agreed with an optimization approach versus 18.9% among those who disagreed (p=0.17). Neurologists newer to clinical practice prescribed high-efficacy DMTs in similar proportions to more experienced practitioners (28.1% 2-9 y post fellowship, 21.1% 10-17 y, 20.8% 18-35 y, p=0.08). First-line use of high-efficacy DMTs did not differ by practice setting, academic affiliation, or MS center affiliation.
While U.S. neurologists report that they prefer an optimization or aggressive approach to MS management, recent DMT initiations among treatment-naive RRMS patients suggest that the traditional escalation approach continues to dominate clinical practice.
Disclosure: Robert T. Naismith consults for Acorda, Alkermes, Biogen, EMD Serono, Genentech, Genzyme, Novartis, Teva.
Jennifer Robinson is the founder of Spherix Global Insights, an independent market intelligence firm and has received no industry funding to conduct and report on this study.
Virginia R. Schobel is an employee of Spherix Global Insights, an independent market intelligence firm and has received no industry funding to conduct and report on this study.