Evolution of high-efficacy treatment strategy for relapsing-remitting multiple sclerosis: A real-life observational study

Abstract

Background: The evolution of the therapeutic arsenal, diagnostic criteria and recommendations concerning treatment in multiple sclerosis (MS) have led to a change in the practices of neurologists in this disease. Our study focuses on the evolution of the prescriptions of a disease-modifying treatment (DMT) in relapsing-remitting (RR) MS by neurologists with a private practice, hospital, or MS center activity, between 2007 (introduction of natalizumab) and 2022 (current practice).

Methods: We conducted a multicenter, descriptive retrospective study, focusing on the prescription of DMTs for patients with RRMS in the Alsace region in France. The study encompassed prescriptions initiated between January 2007 and July 2022, for patients who had undergone a brain MRI within 6 months of disease onset. The DMTs considered as high efficacy included fingolimod, cladribine, rituximab, ocrelizumab, ofatumumab, and natalizumab.

Main results: In our study, focused on the initial prescription of DMTs for RRMS involving a cohort of 1155 patients, we observed a significant time reduction before the first DMT was prescribed, from approximately 1 year during the 2007-2010 period to less than 4 months in the more recent 2018-2022 timeframe. The proportion of high-efficacy treatments (HET) increased notably during the later period interval compared to the earlier ones and there was a discernible change in the profiles of patients initiating HET. These disparities in treatment and patient profiles were particularly pronounced among neurologists practicing within specialized centers or hospitals, in contrast to those engaged in private practices.

Conclusions: These results witness a change in decision-making regarding the prescription of the initial DMT in RR-MS by neurologists between 2007 and 2022.

Keywords: Disease-modifying treatment; Early intensive; Evolution; Flipping the pyramid; Multiple sclerosis; Observational study; Strategy.