Nurses, Physicians’ Assistants Prescribe Antibody-based Therapies More Than Neurologists, Survey Shows

Alice Melão, MSc avatar

by Alice Melão, MSc |

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U.S. nurses and physicians’ assistants prescribe antibody-based disease-modifying therapies to their multiple sclerosis patients more than neurologists do, a survey indicates.

The trend has been for the doctors to stick with interferon therapies, the study said.

Antibody-based disease-modifying therapies are also known as monoclonal antibodies. They are designed to harness the immune system to slow down or stop the destruction of myelin, the protective coating around nerve cells.

Spherix Global Insights conducted the survey, whose findings it presented in the report “RealTime Dynamix: Advanced Practice Providers in Multiple Sclerosis (US).

The annual report provides information about healthcare practitioners’ familiarity with and use of treatments, what therapies they are using more of and less of, and their awareness of therapies in the  development pipeline, according to a Spherix press release.

Fifty-three nurses and physicians’ assistants participated in this year’s survey. Spherix compared the results with those from a survey of 98 neurologists. That report was titled “RealTime Dynamix: Multiple Sclerosis (US).

Nurses and physicians’ assistants are an important care and support group for MS patients. They spend most of their time overseeing patients, including helping relapsing MS patients manage their often complex situations.

A key survey finding was that they prescribe monoclonal antibody therapies such as Biogen’s Tysabri (natalizumab) and Sanofi Genzyme‘s Lemtrada (alemtuzumab) more than neurologists do.

In addition, they adopted Roche’s newly approved therapy Ocrevus (ocrelizumab) earlier than neurologists. In fact, more than twice as many nurses and physicians’ assistants embraced Ocrevus than  doctors.

Another finding was that a significantly higher proportion of nurses and physicians’ assistants prescribe Lemtrada than neurologists.

One reason may be that they have more time than doctors to administer the drug and check for any adverse patient reaction to it. The drug is delivered by IV infusion, which takes time. And afterward patients must be monitored for two hours.

Neurologists rely on injectable or oral therapies that can be administered quickly. They include EMD Serono‘s Rebif (interferon beta-1a) and Biogen’s Tecfidera (dimethyl fumarate).

Another survey finding was that nurses and physicians’ assistants believe the benefits of antibody-based therapies outweigh the risk that patients will develop a complication from the treatment known as progressive multifocal leukoencephalopathy. Neurologists do not share that opinion, according to the survey that covered them.

A lot of MS patients don’t take antibody-based therapies for financial rather than safety reasons, the survey indicated: Basically, their health insurance fails to cover the treatments in many situations, or it provides inadequate coverage. Nurses and physicians’ assistants said they believe this is harming patient care.

Of particular concern is many insurers’ Ocrevus coverage, according to nurses and physicians’ assistants. For example, a lot of insurers cover the drug when a neurologist prescribes it for primary and secondary progressive MS, but not when a nurse or physicians’ assistant prescribes it.

Another survey finding was that pharmaceutical companies recognize the importance of nurses’ and physicians’ assistants’ choice of therapy.

Marketing representatives for several brands, including Lemtrada, Tysabri, Biogen’s Aubagio (teriflunomide), and Teva PharmaceuticalsCopaxone (glatiramer acetate), make more visits to nurses and physicians’ assistants than they do with neurologists, the survey indicated.

The companies also see nurses and physicians’ assistants as information resources, the survey showed. Their representatives often discuss patient care, follow-up, and reimbursement support with nurses and assistants.