Abstract Details

Title Trends in the use of Highly Effective Disease Modifying Treatments in Multiple Sclerosis over 12 years across 10 Sites

Topic Multiple Sclerosis

Presentation(s) S26 - MS and CNS Inflammatory Disease: Clinical Considerations II (1:22 PM-1:33 PM)

Poster/Presentation
Number 003

Background The treatment landscape for MS has dramatically changed. There is currently no universally accepted treatment paradigm. There are two ongoing PCORI funded trials (DELIVER-MS and TREAT-MS) that aim to directly compare initial use of low/moderate efficacy treatments (LMT) vs. HET approaches in early relapsing remitting MS (RRMS). The optimal treatment strategy is not known, which may result in significant practice variability.

Objective To determine changes in prescribing practices of highly effective treatments (HET) in multiple sclerosis (MS) over time across multiple sites.

Design/Methods : Demographics, MS disease history, and iPad® based neuroperformance tests were collected from 10 academic MS centers in the US and Europe utilizing the MSPATHS database. The proportion of HET and LMT was assessed yearly since 1993 through 2018 in the entire RRMS population and treatment naïve population. HET was classified as use of natalizumab, alemtuzumab, ocrelizumab, or rituximab. LMT was classified as use of any other FDA approved therapy for RRMS.

Results 5520 RRMS patients on treatment were identified in MS PATHS (age 46± 11.5 years, female 75%, white 63.5%, education >12 years 72.7%, disease duration 11±8 years, PDDS 0, full time employment 54%, private insurance 58.3%, treatment naïve 37.6%). In the entire RRMS population the first utilization of HET was in 2006 at 27.3% and this has increased to 43.8% in 2018. In a treatment naïve population (n=2060) the first utilization of HET was in 2009 at 9.5% and has increased to 32.3% in 2018. Significant variability was also observed in the proportion of patients treated with HET across different sites.

Conclusions Although the utilization of HET has increased in MS it remains the minority of DMTs used and currently only accounts for about a third of first line treatments used. Treatments strategies continue to significantly vary and more evidence is needed to inform treatment approaches.

Authors/Disclosures
Marisa P. McGinley, DO (Cleveland Clinic) PRESENTER	Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ.
Nicholas Thompson	Nicholas Thompson has nothing to disclose.
	No disclosure on file
Robert A. Bermel, MD, FAAN (Cleveland Clinic)	Dr. Bermel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi/Genzyme. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech/Roche. Dr. Bermel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viela Bio. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck Serono. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca. Dr. Bermel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LabCorp. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Bermel has received research support from Biogen. The institution of Dr. Bermel has received research support from Roche. The institution of Dr. Bermel has received research support from Novartis. Dr. Bermel has received intellectual property interests from a discovery or technology relating to health care.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic)	Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.

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