MS patients in rural regions less likely to receive DMTs, study finds
Education, employment, income may also affect access
People with multiple sclerosis (MS) who live in rural areas are 17% less likely to receive disease-modifying therapies (DMTs) than those in urban regions, a study involving people from the Canadian province of Alberta suggested.
The likelihood was lower when considering therapies that are highly effective at controlling MS, with people in rural areas receiving them 26% less frequently.
In addition to geographical barriers, socioeconomic factors such as education, employment status, and income could explain some of the differences in access to DMTs, the researchers said.
The study, “Inequities in the Use of Disease-Modifying Therapy Among Adults Living With Multiple Sclerosis in Urban and Rural Areas in Alberta, Canada,” was published in Neurology.
“When we don’t treat people living with MS adequately and they are getting worse over time, they face losses and limitations,” Penny Smyth, MD, co-author of the study and a neurologist at the University of Alberta, said in a university news story. “They might have to stop work early or take another type of job. They might have to take disability income. They may not be able to save for retirement, limiting what they can achieve.”
DMTs key to better outcomes
MS is a neurodegenerative condition in which inflammation damages healthy parts of the brain and spinal cord. DMTs can reduce MS disease activity and slow the progression of disability by lessening inflammation.
Because DMTs can improve the long-term outlook for people with MS, it’s important that all patients are able to access them. People who start high-efficacy therapies early in the disease course are more likely to see better outcomes.
Researchers examined data from MS patients in Alberta to see if those living in rural areas have less access to DMTs than patients in urban regions. The analysis involved data on more than 4,500 people who developed MS between 2008 and 2019. Some 15% of them lived in rural areas, and 85% in urban areas.
“The objectives of this study were to compare DMT use and time to initiation of therapy between [people with MS] who resided in rural vs urban areas,” the scientists wrote.
Results showed that people living in rural areas were 17% less likely to have received any DMT than those in urban areas. Statistical analyses indicated that about 39% of this difference could be attributed to variations in socioeconomic status.
DMTs can be broadly classified into two categories: low- to moderate-efficacy DMTs, which are older medicines that are less potent but generally safer, and high-efficacy DMTs, newer therapies that are better at controlling MS but also tend to come with more safety risks.
The analysis showed that rural MS patients were 26% less likely to receive a high-efficacy DMT such as Lemtrada (alemtuzumab), Mavenclad (cladribine), Gilenya (fingolimod), Tysabri (natalizumab), or Ocrevus (ocrelizumab). However, less than 1% of this difference was attributable to socioeconomic factors.
The researchers noted that at the time their analysis was done, many of the available high-efficacy DMTs were given by infusion (a slow drip into the bloodstream), a procedure that needs to be done at a specialty center. People in rural areas often live far from these infusion clinics, which may help explain the discrepancy, the researchers said.
Living far from specialty centers also means that rural patients may find it hard to access specialists like neurologists to help with their care. The scientists said that increasing use of telemedicine, in which clinical appointments are done over the phone or by video call, may help bridge this gap.
“Improvements in access to fully resourced MS specialist neurologists (such as increasing telemedicine access) and increased local health care infrastructure with associated human resources including infusion clinics (whose need will likely continue to rise because practice is shifting toward the early use of induction/higher-efficacy therapies) for [people with MS] who reside in rural areas may support equitable DMT use,” the team concluded.
Although the study focused on Alberta, the results “may be generalized to similar rural areas of industrialized countries,” the researchers wrote.
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