DMTs Underutilized in Younger Patients, Study Indicates

Nearly a third of people with multiple sclerosis (MS) who are younger than 40 are not being treated with disease-modifying treatments (DMTs), even though younger individuals are expected to get the most benefit from DMTs, according to a new study.

“DMTs for MS are more frequently used at younger ages when there is likely higher disease activity, yet a substantial proportion of younger PwMS [people with MS] remains untreated,” researchers wrote.

The study also suggested that a substantial number of older MS patients are being treated with DMTs, even though the benefits of such treatment are less certain.

The study, “Disease-modifying therapy prescription patterns in people with multiple sclerosis by age,” was published in Therapeutic Advances in Neurological Disorders.

DMTs are medications that have been proven in clinical trials to alter the course of MS. To date, more than a dozen have been approved. Because they slow the progression of disease over time, DMTs are expected to be of greater benefit to relatively young MS patients who are still fairly early on in their disease, as compared to elderly patients with more advanced MS. Because of this, in part, many MS clinical trials have excluded participants older than 55.

In the new study, a team of researchers in the U.S. analyzed two large MS registries to assess how patterns of DMT use varied with age.

“The objective of this study was to determine the frequencies of DMT prescriptions in relation to age in the real-world setting,” the team wrote.

The two registries in question are the North American Research Committee on Multiple Sclerosis (NARCOMS), and the Multiple Sclerosis Surveillance Registry (MSSR). Of note, the NARCOMS registry includes data for the general population of MS patients, while the MSSR, which was established by the U.S. Veterans Health Administration, specifically collects data on U.S. veterans with MS.

In total, the researchers assessed data for 6,948 people in the NARCOMS registry and 1,719 patients in the MSSR. Overall rates of DMT usage were similar in the two registries: 47.9% in NARCOMS and 54.5% in MSSR.

In both datasets, substantially more younger patients than older patients were prescribed a DMT.

Specifically, 29.5% of patients ages 71–80 in the NARCOMS registry were prescribed a DMT, as compared with 61.4% of patients 40 or younger. In MSSR, 27.2% of patients ages 71–80 were prescribed a DMT, compared with 70.5% of individuals 40 or younger.

“Real-world data from NARCOMS and the MSSR showed decreasing frequencies of DMT use with age,” the researchers concluded. “Nevertheless, almost a third of younger PwMS below age 40 appear not to be using DMTs despite widespread recognition of the importance of early treatment in MS.”

In addition to showing that many young MS patients are not getting DMTs that could benefit them, the data illustrate that a substantial portion of elderly patients are getting DMTs — even though the benefits and safety of DMTs in the elderly population is less certain, as evidence suggests a lower risk of relapse due to a less active immune system.

“The continued use of DMTs in the elderly may be the result of the perceived notion that disease inactivity is due to treatment rather than the natural disease course with aging,” the team wrote.

The team called for further research on the effects of DMTs in elderly patients, and into strategies that could help get younger patients medications that are known to be effective.

Of note, the researchers found that, in the MSSR, 70.5% of patients ages 31–40, and 72.5% of those ages 41–50, were on a DMT. By contrast, the respective rates of DMT use were lower in the NARCOMS registry: 61.5% for patients ages 31–40, and 62.7% for those ages 41–50. No substantial differences in rates of DMT uses were found among other age groups.

The researchers speculated that this difference might be explained, at least in part, because participants in the MSSR — being veterans — may have easier access to healthcare and DMTs. They wrote that “costs of DMTs are uniformly lower in the integrated VA health care system [than the overall U.S. healthcare system], due in part to the ability to negotiate prices with the pharmaceutical industry.”

“Addressing the undertreatment of younger PwMS who are more likely to benefit from DMT use requires ongoing efforts to improve DMT access,” the team added.