Use of disease modifying agents in patients with multiple sclerosis: Analysis of ten years of national data

Jagadeswara R Earla; Rutugandha Paranjpe; Nandita Kachru; George J Hutton; Rajender R Aparasu

doi:10.1016/j.sapharm.2020.02.016

Use of disease modifying agents in patients with multiple sclerosis: Analysis of ten years of national data

Res Social Adm Pharm. 2020 Dec;16(12):1670-1676. doi: 10.1016/j.sapharm.2020.02.016. Epub 2020 Mar 11.

Authors

Jagadeswara R Earla¹, Rutugandha Paranjpe², Nandita Kachru³, George J Hutton⁴, Rajender R Aparasu⁵

Affiliations

¹ Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. Electronic address: Jagadesh.e.rao@gmail.com.
² Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. Electronic address: rutugandha89@gmail.com.
³ Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. Electronic address: nanditakachru@gmail.com.
⁴ Baylor College of Medicine, Houston, TX, USA. Electronic address: ghutton@bcm.edu.
⁵ Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA. Electronic address: rraparasu@uh.edu.

PMID: 32171597
DOI: 10.1016/j.sapharm.2020.02.016

Abstract

Background: Disease modifying agents (DMAs) are used to reduce relapses and decrease disability progression in Multiple Sclerosis (MS) patients. However, limited national level data exists regarding the prescribing patterns for MS, especially after the introduction of oral DMAs.

Objective: This study examined the prescribing patterns and trends of DMAs using national level data and determined the factors associated with prescribing DMAs among MS patients in the United States.

Methods: This cross-sectional study utilized 2006-2015 National Ambulatory Medical Care Survey (NAMCS) data to examine office-based visits involving MS (ICD-9-CM code 340). Descriptive weighted analyses were performed to assess the prescribing patterns of DMAs. Multivariable logistic regression model within the conceptual framework of Andersen Behavioral Model was used to determine the factors associated with prescribing of DMAs among MS patients.

Results: An estimated 8.5 million (95% Confidence Interval [CI] 7.01-10.09 million) MS patient visits were identified from 2006 to 2015. During the ten-year study period, 3.84 million (45%) MS visits involved prescribing of DMAs. The majority of DMA prescriptions were injectables (78%), followed by infusions (11%) and orals (11%). Oral DMAs use increased (from 11% in 2010-2011 to 40% in 2014-2015), whereas the use of injectable DMAs decreased (from 96% in 2006-2007 to 52% in 2014-2015) during the study period. Multivariable analyses revealed that predisposing (age and region) and enabling (physician specialty) factors were significantly associated with prescribing of DMAs among MS patients. Visits to neurologists (Odds Ratio [OR] 6.61, 95% CI 3.66-11.93) were associated with higher odds of being prescribed with DMAs.

Conclusion: During the ten-year study period, increasing use of oral DMAs and declining use of injectable DMAs was observed. Both predisposing and enabling factors influenced the prescribing of DMAs. With increasing availability of oral DMAs, the DMAs use is likely to increase among MS patients.

Keywords: Cross-sectional study; Disease modifying agents (DMAs); Multiple sclerosis; National ambulatory medical care survey (NAMCS); Neurologist; Prescribing pattern.

MeSH terms

Cross-Sectional Studies
Health Care Surveys
Humans
Logistic Models
Multiple Sclerosis* / drug therapy
Office Visits
Practice Patterns, Physicians'
United States