Progressive Multiple Sclerosis Treatment Patterns and Therapy Selection Considerations: Patient-Level Retrospective Chart Audit Data Comparison By Managing Physician Specialty

Background: Patients diagnosed with multiple sclerosis (MS) may be managed by either a general neurologist or an MS specialist.

Objectives: To compare perceptions, treatment patterns, and the disease-modifying therapy (DMT) selection process among patients with progressive MS (PMS) by specialty of the managing physician.

Methods: In September 2021, US neurologists completed an online questionnaire and contributed chart reviews for a retrospective, cross-sectional audit of DMT-treated patients diagnosed with a progressive form of MS (n=148 physicians; n=758 charts), including secondary progressive MS (SPMS) or primary progressive MS (PPMS). Analyses were restricted to data collected from general neurologists (n=90 physicians; n=445 charts) and MS specialists (n=53 physicians; n=286 charts).

Results: The proportion of contributed patient charts by progressive MS subtype and time since initiation of current DMT by PMS subtype did not differ between specialties. Commercial insurance coverage was more common among active SPMS patients managed by specialists (79% vs. 62%).

Ocrelizumab was the most commonly prescribed DMT for both specialties. Interferon treatment was more common for active SPMS (20% vs. 9%) and PPMS (15% vs. 5%) patients managed by general neurologists, whereas glatiramer acetate (GA) agent share was higher for PPMS patients managed by specialists (14% vs. 7%). High-efficacy oral DMT treatment (40% vs. 16%) was more common among not active SPMS patients managed by specialists, with cladribine treatment especially more frequent (11% vs. 2%). Across PMS subtypes, specialists were more likely to treat patients with a generic agent (generic GA: 8% vs. 2%; generic dimethyl fumarate: 4% vs. <1%).

Regardless of PMS subtype, the selection of the current DMT was strongly influenced by inflammatory disease activity reduction and disability progression delay expectations. Specialists were more influenced by inflammatory disease activity reduction expectations (30% vs. 19%) and less by managed care preference (2% vs. 6%) when selecting a DMT for active SPMS, while tolerability profile (8% vs. 6%) and low cost to patient (6% vs. 2%) were more influential in selections for PPMS. Attribute influence during the DMT selection process did not differ significantly between specialties for not active SPMS.

Conclusions: PMS treatment may differ depending upon the specialty of a patient’s managing physician. Among specialists, a greater focus on reducing inflammatory disease activity drives less use of interferons, while tolerability and cost concerns maintain the reliance on GA agents. With no approved therapy for not active SPMS, specialists are especially likely to rely on high-efficacy oral DMTs approved for RMS.