April 15, 2021
Patients with Not Active Progressive Multiple Sclerosis in the United States: Profiling an Underserved Segment
Authors: Virginia R. Schobel, MSc; Meg M. Stabb
Compare clinical presentation, treatment history, and drivers of therapy choice of active and not active patients with progressive multiple sclerosis (MS).
No disease-modifying therapy (DMT) is currently approved in the US for not active progressive MS, although multiple agents are currently in late-stage clinical development.
In July/August 2020, US neurologists contributed chart review data for 764 DMT-treated secondary progressive (SPMS) or primary progressive (PPMS) MS patients. Not active patients (n=144) were defined by lack of relapse in preceding 12 months or gadolinium-enhancing or T1 lesion on the most recent brain MRI.
Not active patients are more likely to be diagnosed with PPMS (56% vs. 36%), but designation of not active SPMS does not differ between groups. Neurologists describe more not active patients as having stable disability (48% vs. 37%) and reportedly less disability (mean Expanded Disability Status Scale score: 2.9 vs 3.6; median: 2.5 vs. 3.5) than active patients. Among patients reported to have disability progression, progression is believed to occur independent of relapse activity (PIRA) for most patients in both groups (94% vs. 86%).
Not active patients less frequently switched DMTs in the past year (20% vs. 42%) and are more often on their first DMT (52% vs. 37%) compared to active patients. More not active than active patients are currently prescribed ocrelizumab (49% vs. 35%), with disability progression delay (29% vs. 22%) more influential in therapy selection for not active patients. Neurologists rate willingness to prioritize high efficacy above safety risk when selecting a therapy lower (6.7 vs. 7.3 on 10-point scale) for not active patients.
Among patients with progressive forms of MS, not active patients have less disability and lower therapeutic churn than active patients. Products in development for not active progressive MS will need to demonstrate efficacy in reducing PIRA, while providing a balanced risk/benefit profile.
Virginia Schobel and Meg Stabb are employees of Spherix Global Insights, an independent market intelligence firm, and have received no industry funding to conduct and report on this study.
Archived AAN Abstracts:
- Understanding the Impact of Sex and Race on the Migraine Patient’s Journey in the United States: Analyses From an Annual Cross-Sectional Patient Chart Audit
- 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
- Evolving Diagnosis and Treatment of Secondary Progressive Multiple Sclerosis in the United States
- Multiple Sclerosis Disease-Modifying Therapy: Recent Switch Patterns Among United States Neurologists