Diagnostic Criteria and Differential Diagnosis Poster Presentation

P0252 - Evolving diagnosis and treatment of secondary progressive multiple sclerosis in the United States (ID 400)

Speakers
  • V. Schobel
Authors
  • R. Naismith
  • V. Schobel
Presentation Number
P0252
Presentation Topic
Diagnostic Criteria and Differential Diagnosis

Abstract

Background

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.

Objectives

Evaluate how US Neurologists are diagnosing secondary progressive (SP) multiple sclerosis (MS) over time. Determine how treatment choices for SPMS are evolving.

Methods

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).

Results

SPMS transition was diagnosed most commonly by a progressive accumulation of disability independent of relapse activity (57% of patients). 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%). Compared to the prior year, the proportion with active SPMS increased (66% vs. 58%), 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%). Siponimod and cladribine use was introduced in 2019, while fingolimod and dimethyl fumarate use declined from 2018 levels.

Conclusions

US Neurologists continue to evolve in diagnosing SPMS, using the active SPMS subtype, and in treatment choices for such patients.

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