Equal DMT Use Found in Norway Despite Socioeconomic Status: Study

People newly diagnosed with multiple sclerosis (MS) in Norway have in recent years received disease-modifying therapies (DMTs) independent of their socioeconomic status, according to a new analysis.

These findings do not support previous reports indicating that fewer DMTs are prescribed for the most socially deprived MS patients, the researchers noted.

While acknowledging that, up to 15 years ago, a patient’s “level of education, household income and marital status were inversely related to access” to a high-efficacy DMT as a first prescribed therapy, the team found that greater treatment equality has occurred in the last decade.

Overall, the researchers concluded that, in Norway since about 2012, there has been “a change over time to a current pattern where the [MS patients] are treated broadly equally with DMT regardless of socioeconomic position.”

The study, “The influence of socioeconomic factors on access to disease modifying treatment in a Norwegian multiple sclerosis cohort,” was published in Multiple Sclerosis and Related Disorders.

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February 27, 2019 News by Joana Carvalho, PhD

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More than a dozen DMTs are widely approved for MS treatment. These medications can alter the course of the disease, preventing relapses and delaying the progression of disability.

Socioeconomic status — a broad term encompassing a combination of factors related to education, income, and occupation — can have a profound effect on health outcomes. MS patients with lower socioeconomic status are generally thought to have less ability to access DMTs.

Now, a team of scientists conducted an analysis involving data for 1,314 people in Norway with relapsing-remitting MS (RRMS) who were diagnosed before 2018. Overall, about two-thirds (902 patients) had been treated with a DMT.

“The aim of this descriptive study was to investigate if socioeconomic factors have an impact on access to DMTs in MS, with a special focus on access to high efficacy DMTs, in a population-based [patient group] in the South-East of Norway,” the researchers wrote.

Data broadly indicated that access to DMTs had increased over time. Among 205 MS patients diagnosed before 1997, less than 40% were treated with a DMT. By comparison, more than 80% of those diagnosed after 2012 were treated with a disease-modifying therapy.

Patients who were treated at some point with a DMT were generally younger — both when they were diagnosed and at the time the study was conducted — than individuals who had never received a DMT. Those receiving a DMT also had less substantial physical disability, again, both at diagnosis and during the study’s timeframe, compared with those not treated with a modifying therapy.

Notably, analyses of the patients diagnosed between 2012 and 2017 (396 cases) showed no differences in DMT use based on socioeconomic status. Another analysis that included patients diagnosed from 2007 to 2017 (715 cases) showed similar results.

“There are no significant differences in any of the socioeconomic parameters between never-treated and ever treated pwMS [people with MS] in the subgroup diagnosed 2012-2017,” the researchers wrote. “We have performed the same analysis on the subgroup diagnosed 2007-2017 with the similar results.”

“Our main finding is that contemporary pwMS are treated broadly equally with DMT in terms of socioeconomic position in this Norwegian [patient population]. Our findings consequently do not support previous reports of less DMT prescribing to the most socially deprived pwMS,” the team concluded.

In other analyses, the DMTs were divided into moderate-efficacy or high-efficacy therapies. The latter category includes Tysabri (natalizumab), Gilenya (fingolimod), Lemtrada (alemtuzumab), rituximab (used off label in MS), and Mavenclad (cladribine).

Results showed that patients with less formal education were generally more likely to be initially prescribed a high-efficacy DMT. A lower household income also was associated with a greater likelihood of high-efficacy treatment in the overall analysis, though this association was not apparent when only the most recently diagnosed patients were analyzed.

Patients given earlier treatment with high-efficacy DMTs also tended to have more substantial physical disability, which “is likely a sign of more severe disease at diagnosis and, consequently, more active treatment from the beginning,” the researchers wrote. “We believe this represents a change in the treatment pattern among neurologist with an increasing focus on personalized treatment.”

The time to start a high-efficacy treatment generally did not vary with socioeconomic factors, though the researchers noted that high-efficacy therapies tended to be started sooner in patients who lived in rural areas or who reported lower household income. The team noted that low-income and rural patients tend to have more severe, disabling MS when they are diagnosed, likely explaining these differences.

The scientists noted a number of limitations in this study, including a lack of clinical and MRI data that likely informed some of the treatment decisions.