AI Proposed to Help Thwart MS Treatment Delays, Discontinuation

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by Marta Figueiredo, PhD |

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Patients’ underestimation of their own disease and the cost and side effects of disease-modifying therapies (DMTs) are among the main causes of delayed treatment initiation and non-adherence in multiple sclerosis (MS) patients, according to a report from OptimizeRx.

These findings help uncover areas for improvement, which the health technology company believes may be targeted through digital solutions that support timely diagnosis and treatment, and help patients stay with prescribed medications.

“Understanding key factors that delay new patient starts on therapy is critical to reaching and educating both providers and MS patients,” Adam Almozlino, vice president of OptimizeRx’s artificial intelligence (AI) solutions, said in a press release.

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“Personalized outreach and education can help get patients on the right therapy early and help keep them adherent to prevent disease progression,” Almozlino added.

To speed diagnosis, OptimizeRx would leverage advanced analytics and machine learning to analyze clinical data “to create predictive profiles” of people suspected of having MS, Almozlino said.

Advanced analytics can also be applied to “proactively identify HCPs [healthcare professionals] treating those patients along the journey and predict the best moments to share MS treatment information with those HCPs at the point of care,” Almozlino added.

Over the past three decades, 22 DMTs were approved in the U.S. to treat MS, further emphasizing the importance of understanding the drivers of and barriers to treatment choice, initiation, and continuation.

While the prevailing view among neurologists, supported by increasing clinical evidence, is that early and continuous treatment has a positive effect on MS patients’ long-term outcomes, “numerous challenges remain to get a subset of MS patients to start and/or stay on therapy,” OptimizeRx stated in the report.

The report highlighted that delayed referral to specialists, mild initial symptoms, lack of access to high-cost DMTs, and side effect concerns are the main causes of delayed treatment initiation among MS patients.

A 2017 survey of 5,300 MS patients in the U.S. showed that 42% were initially misdiagnosed with other conditions — such as depression, migraine, and fibromyalgia — and that almost half required five physician office visits to be diagnosed with MS.

“The lack of specific markers for an MS diagnosis and the dependence on medical history and a neurological examination make it particularly challenging for the inexperienced physician to quickly recognize the need to refer a patient to a specialist,” the company stated in the report.

After a correct diagnosis, many patients may still delay treatment due to milder initial symptoms. Without understanding the importance of an early start in slowing disease progression, mild symptoms give them the perception that they can wait to start treatment. This is especially true for DMTs, which carry the risk of severe side effects.

“What patients do not see in the early stages of MS is the damage to the brain and spinal cord that underlies the most challenging outward manifestations of the disease,” the report stated.

Concerns over DMTs’ side effects, as well as access challenges in acquring them — due to insurance requirements, coverage limitations, and/or their high cost — also contribute to delayed treatment in this patient population.

According to the National Multiple Sclerosis Society, DMT prices have steadily increased over the last seven years, with the median annual cost of branded DMTs reaching $91,835 in 2020. Even for patients who have insurance, the high out-of-pocket costs of DMTs prompt as many as 14% of them to forgo therapy because they cannot afford it, the company report states.

“When patients are not getting referred to MS specialists in a timely manner or are not being educated on the benefits of early treatment initiation and how to weigh treatment risks versus clinical benefit, it is the beginning of a perfect storm for delayed treatment; add in the high cost of DMTs and it is a perfect … storm,” the report noted.

Moreover, even after starting DMTs, 40% of MS patients stop treatment about three years later, the company reported, citing a research study.  The main reasons for DMT discontinuation and non-adherence include their high cost, side effects, lack of perceived efficacy, and coping avoidance, a coping mechanism characterized by avoiding dealing with the problem directly and instead disengaging from the situation.

Given that DMTs’ positive effects on brain and spinal cord lesions may not result in reductions in the many symptoms of MS, patients may forgo them because they do not think the treatment is working.

“Convincing patients to stay on therapy and to have the patience with switching therapies or adjusting dosing to get optimal results is yet another challenge that is only complicated by the fact that DMTs do not alleviate MS symptoms,” OptimizeRx noted in the report.

The company believes that digital technology can support treatment initiation and adherence by applying AI-driven predictive analysis to real-world evidence to help identify patients who should be referred to an MS specialist for earlier diagnosis.

The creation of digital adherence programs can provide personalized educational resources on DMTs throughout treatment, and streamline access to financial assistance programs. This can help patients better cope with and manage their disease and increase treatment access.

OptimizeRx’s Therapy Initiation and Persistence Platform is focused on helping patients start and stay on therapy and currently connects over 60% of U.S. healthcare providers and millions of their patients, according to the release.

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