Socioeconomic status and disease-modifying therapy prescribing patterns in people with multiple sclerosis

Saúl Reyes; Sebastian Suarez; Kimberley Allen-Philbey; Özlem Yildiz; Joela Mathews; Grace Anjorin; Freya Edwards; Cherry Jain; Benjamin Turner; Monica Marta; Sharmilee Gnanapavan; Klaus Schmierer; Gavin Giovannoni

doi:10.1016/j.msard.2020.102024

Socioeconomic status and disease-modifying therapy prescribing patterns in people with multiple sclerosis

Mult Scler Relat Disord. 2020 Jun:41:102024. doi: 10.1016/j.msard.2020.102024. Epub 2020 Feb 24.

Authors

Affiliations

¹ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom; Department of Neurology, Royal London Hospital, Barts Health NHS Trust, 7000 Whitechapel Road, Whitechapel, London, E1 1FR, United Kingdom. Electronic address: saul.reyes@nhs.net.
² Department of Internal Medicine, Boston Medical Centre, Boston, MA, 02118, United States.
³ Department of Neurology, Royal London Hospital, Barts Health NHS Trust, 7000 Whitechapel Road, Whitechapel, London, E1 1FR, United Kingdom.
⁴ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom; Department of Neurology, Royal London Hospital, Barts Health NHS Trust, 7000 Whitechapel Road, Whitechapel, London, E1 1FR, United Kingdom.
⁵ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, Whitechapel, London, E1 2AT, United Kingdom.

PMID: 32143179
DOI: 10.1016/j.msard.2020.102024

Abstract

Aims: To examine the association between socioeconomic status (SES) and disease-modifying therapy (DMT) prescribing patterns in people with relapsing-remitting multiple sclerosis (pwRRMS).

Methods: A cross-sectional analysis was conducted among pwRRMS treated with a DMT in the neuroinflammation service at The Royal London Hospital (Barts Health NHS Trust). Study data were collected between July and September 2017. SES was determined by patient income and education extracted from the English Index of Multiple Deprivation. Based on their efficacy, DMTs were categorized as moderate efficacy (Glatiramer Acetate and Beta-Interferons), high efficacy (Cladribine, Fingolimod and Dimethyl Fumarate) and very-high efficacy therapies (Natalizumab and Alemtuzumab). Multinomial logistic regressions were performed for univariate and multivariate models to assess differences between SES and DMT prescribing patterns.

Results: Treatment consisted of moderate efficacy (n = 76, 12%), high efficacy (n = 325, 51.3%) and very-high efficacy therapies (n = 232, 36.7%). Medians for income and education deciles were 4 (IQR 3-7) and 6 (IQR 4-8), respectively. After multinomial logistic regression analysis, patient income was not associated with increased odds of being treated with high efficacy (OR, 0.92; 95% CI, 0.82-1.04; p = 0.177) or very-high efficacy DMTs (OR, 0.95; 95% CI, 0.85-1.06; p = 0.371). Similarly, patient education was not associated with being treated with high efficacy (OR, 0.91; 95% CI, 0.80-1.03; p = 0.139) or very-high efficacy therapies (OR, 0.92; 95% CI, 0.81-1.04; p = 0.188).

Conclusions: SES was not predictive of DMT prescribing patterns in pwRRMS. Whilst this appears reassuring within this universal health care setting, the same methodology needs to be applied to other MS services for comparison. Data could then be further interrogated to explore potential socioeconomic inequities in DMT prescribing patterns across the UK.

Keywords: Disease-modifying treatments, Socioeconomic status; Education; Income; Multiple sclerosis.

MeSH terms

Adult
Drug Prescriptions / statistics & numerical data*
Educational Status
Female
Humans
Immunologic Factors / therapeutic use*
Income
Male
Multiple Sclerosis, Relapsing-Remitting / drug therapy*
Practice Patterns, Physicians' / statistics & numerical data*
Social Class*
United Kingdom

Substances

Immunologic Factors