Treatment patterns and comorbid burden of patients newly diagnosed with multiple sclerosis in the United States

• Published in: BMC neurology 2020-08, Vol.20 (1), p.296-8, Article 296
• Main Authors: Kern, David M, Cepeda, M Soledad
• Format: Article
• Language: English
• Subjects: Administrative claims; Cardiovascular Diseases - epidemiology; Care and treatment; Codes; Comorbidity; Data models; Databases, Factual; Diabetes mellitus; Diagnosis; Dimethyl fumarate; Dimethyl Fumarate - therapeutic use; Disease modifying therapy; Drug Utilization - statistics & numerical data; Female; Fingolimod; Glatiramer Acetate - therapeutic use; Health insurance; Humans; Hyperlipidemia; Insurance claims; Interferon; Male; Medicare; Mental disorders; Mental Disorders - epidemiology; Middle Aged; Multiple sclerosis; Multiple Sclerosis - diagnosis; Multiple Sclerosis - drug therapy; Multiple Sclerosis - epidemiology; Patients; Prescription drugs; Retrospective Studies; Teriflunomide; Treatment patterns; United States
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-020-01882-2

The treatment landscape for multiple sclerosis (MS) is quickly evolving. Understanding real-world treatment patterns of patients is necessary to identifying potential gaps in care. Patients with incident MS were identified from a large national claims database during 1/1/2014-6/30/2019. Patients had ≥2 diagnoses for MS or an inpatient hospitalization with a primary diagnosis of MS. Patients were required to have enrollment in the database ≥1 year prior to and ≥ 1 year following their first MS diagnosis. Treatment sequences were captured for all available disease modifying therapies (DMTs) during all available follow-up. Presence of comorbid conditions were captured during the one year prior to and following (and including) the index date; absolute change in prevalence from the pre- to post-index periods was calculated. We identified 5691 patients with incident MS. Common comorbidities included physical symptoms (e.g., pain, weakness, fatigue), mental health conditions (anxiety, depression), and cardiovascular/metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity). Just 1994 (35.0%) of patients received a DMT at any time during follow-up. Of those receiving a DMT, 28.2% went on to receive a second line of therapy, 5.8% received a third, and just 0.9% went on to a fourth line. Use of more than one DMT concomitantly occurred in just 1.8% of all treated patients. Glatiramer and dimethyl fumarate were by far the most common first-line treatments received accounting for nearly 62% of patients receiving a DMT. Approximately two-thirds of patients newly diagnosed with MS did not receive a DMT and the disease is accompanied by a significant comorbid burden.