April 25, 2020
Evolving Diagnosis and Treatment of Secondary Progressive Multiple Sclerosis in the United States
Authors: Robert T. Naismith, MD; Jennifer Robinson; Virginia R. Schobel, MSc
Evaluate how US Neurologists are diagnosing secondary progressive (SP) multiple sclerosis (MS) over time. Determine how treatment choices for SPMS are evolving.
In 2019, the FDA changed the prescribing information to include active SPMS for siponimod, in addition to natalizumab, ocrelizumab, cladribine, fingolimod, dimethyl fumarate, interferons, and glatiramer acetate.
US Neurologists contributed online chart reviews for a cross-sectional audit of patients with SPMS in Q3 2018 (n=168 physicians; 431 SPMS patients) and Q3 2019 (n=147 physicians; 423 SPMS patients).
• SPMS transition was diagnosed most commonly by a progressive accumulation of disability independent of relapse activity (57% of patients; Fig. 1). SPMS diagnosis in 2019 relied more upon confirmed disability progression (CDP) over 6 months (25% vs. 16% in 2018) and increased rate of brain atrophy (15% vs. 9%). Neurologists relied less upon absence of relapses (12% vs. 24% in 2018), length of time since MS diagnosis (11% vs. 16%), and a decreased annualized relapse rate (6% vs. 11%).
• In 2019, MS Specialists (n=85) were more likely to identify SPMS by CDP-6M (33% vs. 14%), whereas General Neurologists (n=61) relied more on worsening MRI findings (50% vs. 30%) and decreased walking speed (26% vs. 14%; Fig. 2).
• Compared to the prior year, the proportion with active SPMS increased (66% vs. 57%; Fig. 3), with MS Specialists more likely to categorize SPMS patients active compared to General Neurologists (73% vs. 59%).
• SPMS patients were most likely to be treated with an oral DMT (34%), followed closely by monoclonal antibodies (32%; Fig. 5). Siponimod and cladribine use was introduced in 2019, while fingolimod and dimethyl fumarate use declined from 2018 levels.
US Neurologists continue to evolve in diagnosing SPMS, using the active SPMS subtype, and in treatment choices.
Robert T. Naismith consults for Alexion, Alkermes, Biogen, Celgene, EMD Serono, Genentech, Genzyme, Novartis, TG Therapeutics, and Viela Bio. He is an editor for NEJM Journal Watch.
Jennifer Robinson is the founder of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
Virginia R. Schobel is an employee of Spherix Global Insights, an independent market intelligence firm, and has received no industry funding to conduct and report on this study.
Archived AAN Abstracts:
- Anti-CGRP Class Reduces Migraine Burden Regardless of Concomitant Therapies in US Clinical Practice
- Changing Patterns in Disease-Modifying Therapy Selection for Treatment-Naive Multiple Sclerosis in the United States
- Multiple Sclerosis Disease-Modifying Therapy: Recent Switch Patterns Among United States Neurologists