MS patients in UK less likely to be on treatment, new study shows
MS Society UK calls for action to improve access to DMTs, other care
People with multiple sclerosis (MS) in the United Kingdom are less likely to be on disease-modifying treatments (DMTs) compared with MS patients in other countries in Europe, a new study reports.
“We know that getting early treatment with disease-modifying MS therapies can improve long term health and wellbeing. More than 130,000 people live with MS in the UK, and this research shows many are not getting the same opportunities as those in other countries,” Clare Walton, PhD, head of research at MS Society UK, said in a press release.
According to the MS Society UK, a prime factor is what the advocacy group calls “tighter checks in place in the UK for people to access DMTs” using the National Health Service (NHS), the publicly funded healthcare systems in Great Britain.
“For years, neurology services in the UK have been neglected, underfunded, and deprioritised,” Walton said, adding, “Improving access to neurologists and MS specialists is key to improving the treatment landscape and quality of life for people living with MS. The government must take action by working with the NHS to build a sustainable neurology workforce.”
The study, “The impact of healthcare systems on the clinical diagnosis and disease-modifying treatment usage in relapse-onset multiple sclerosis: a real-world perspective in five registries across Europe,” was published in Therapeutic Advances in Neurological Disorders.
Study investigated use of DMTs by MS patients across Europe
The new study was funded by Novartis, which sells several approved DMTs, including Mayzent (siponimod), Gilenya (fingolimod), Extavia (interferon beta-1b), and Kesimpta (ofatumumab).
DMTs are medications that work to suppress inflammation and have been proven in clinical trials to decrease the risk of disease flares and reduce the likelihood of worsening disability.
In Europe, most DMTs specifically are approved to treat relapsing-remitting MS (RRMS), the most common form of the disease. It’s characterized by relapses where symptoms worsen, followed by periods of remission in which symptoms ease or disappear entirely.
Over time, many people with RRMS will move into a different disease type called secondary progressive MS (SPMS), which is marked by symptoms continuously worsening over time.
Most DMTs approved for RRMS in Europe are not officially authorized for SPMS because they are thought to be less effective at controlling progressive disease. It is fairly common, however, for SPMS patients to nonetheless be prescribed these therapies.
To learn more about DMT use across the continent, researchers from The SPMS Research Collaboration Network now examined data collected from 2017 to 2019, looking at patterns for the use of such treatments. Information was collected from large databases in five European countries — the Czech Republic, Denmark, Germany, Sweden and the U.K. — and covered a total of 64,235 people with RRMS or SPMS.
“There are wide differences in the health, health provision and treatment of [people with] MS throughout Europe,” the scientist wrote.
“We are the first to integrate an analysis of disease and demographic factors with health system features to try to determine how they influence DMT prescribing,” the team wrote.
There are wide differences in the health, health provision and treatment of [people with] MS throughout Europe.
In the total population, about three-quarters of RRMS patients were on a DMT, as were about 1 in 3 patients with SPMS. In both disease types, the rate of DMT use was significantly lower in the U.K. compared with other countries. Conversely, Sweden had the highest rates of highly active DMT use for both RRMS and SPMS patients.
Among patients who had ever been prescribed a DMT, patients with SPMS were more likely to have stopped treatment than those with RRMS. The rate of stopping treatment was higher for SPMS patients in the U.K. than in other countries, though for RRMS patients, rates of stopping treatment were similar in all five countries.
Audits in UK seen to significantly impact DMT access for patients
According to the researchers, the study’s findings may be explained, in part, by the fact that the U.K.’s healthcare system conducts regular audits to ensure that people with MS are receiving treatment in line with approved guidelines — if not, the country’s publicly-funded health insurance program may refuse to cover the cost of treatment.
In fact, statistical models predicted that, if similar auditing practices were applied in Sweden, rates of DMT usage in that country would be reduced below those seen in the U.K.
“The clinical label is the primary factor enabling DMTs to be used, whereas the specific health systems’ approach to verifying compliance with the label can be very effective in limiting prescribing,” the researchers wrote.
The MS Society UK noted in its release that the NHS audits are used to determine if treatments are “considered appropriate for the person’s specific diagnosis and stage of MS.”
“So while fewer people in the UK might be on DMTs, it might be that more people are on the right DMT,” the nonprofit stated.
Statistical analyses also showed that, across countries, female RRMS patients were less likely to be on a DMT compared with male patients. Among SPMS patients, the odds of being on a DMT were lower among those with more disability — and among patients undergoing regular medical monitoring.
“Treatment is less common in clinically diagnosed women with RRMS and in clinically diagnosed SPMS in those with a higher [disability score] and where there is monitoring by the health system,” the researchers wrote.
There isn’t a clear biological distinction between RRMS and SPMS; differentiating these two MS subtypes in clinical practice is a somewhat subjective practice. Generally, patients can be diagnosed with SPMS if they experience at least six months of continual disease progression, independent of relapses — but there is some variability among clinicians.
The researchers conducted further tests where they used an algorithm to analyze available clinical data and classify patients as RRMS or SPMS. They then compared these classifications with patients’ actual recorded diagnoses, and assessed whether the differences affected DMT use.
The results showed that, among patients with a clinical diagnosis of SPMS, the odds of starting on a DMT weren’t different between patients that the algorithm classified as RRMS or SPMS. However, SPMS patients classified as such by the algorithm were significantly more likely to have stopped treatment compared with RRMS patients reclassified by the algorithm as having SPMS.
“We show that there is no difference between the chance of starting or escalating DMTs in clinical SPMS regardless of the population’s standardised diagnosis being SPMS or RRMS. In contrast, DMTs are stopped more often when both the standardised diagnosis, and the clinical diagnosis is SPMS,” the researchers wrote, noting that this finding is “in agreement with general view that DMTs have less efficacy in SPMS.”
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