CE Outcomes LLC

Author Of 1 Presentation

Observational Studies Poster Presentation

P0926 - Therapeutic Practices in Multiple Sclerosis (MS) Amongst General Neurologists and MS Specialists (ID 1365)

Speakers
Presentation Number
P0926
Presentation Topic
Observational Studies

Abstract

Background

The rapid development of MS disease modifying therapies (DMTs) has substantially complicated decision-making for clinicians. Despite the availability of 18 DMTs spanning nine therapeutic classes, few of these agents have been compared head-to-head and only recently were consensus-based guidelines published on their use. Almost no publicly available information exists about how practicing neurologists are approaching the contemporary management of this population.

Objectives

To assess potential discrepancies in clinical decisions between neurologists who specialize in MS and those who treat MS but do not subspecialize.

Methods

An online survey was conducted in May 2020. US and Canadian neurologists practicing in academic or specialized MS centers were invited to participate. A random sample of US generalists who practice in community-based, non-specialized settings but see 5-20 MS patients each week were also recruited. Questions were formulated to assess differences regarding strategic approaches to case-based scenarios.

Results

A total of 25 experts and 100 general neurologists completed the assessment. Experts were more likely to offer high efficacy DMTs across a variety of clinical presentations (e.g. CIS by age, RRMS, pregnancy, PPMS). For a 25-year-old female patient with CIS, the largest cohort of experts prioritized ocrelizumab (30%) vs. 2% of generalists (p<0.001). Generalists preferred glatiramer acetate (GA) (34%) vs. 0% of experts (p<0.001). For a 29-year-old female (JCV negative) with moderate risk disease, 84% of experts selected either natalizumab or ocrelizumab, compared to 43% of generalists (p<0.001). For a 29-year-old with higher risk MS and plans to become pregnant, 76% of experts chose ocrelizumab (8% of generalists, p<0.001) while 44% of generalists recommended GA (0% of experts, p<0.001). Both groups trended more towards high efficacy therapies in response to radiologic disease activity vs. clinical relapses with stable imaging.

Conclusions

There were several group commonalities including DMT initiation, the impact of race, and therapeutic response to breakthrough disease. However, substantial differences were seen in DMT choice, switching behavior, use in patients contemplating pregnancy, and age variation. Experts typically prioritized higher efficacy agents while generalists typically prioritized safety profile. This suggests that approaches are heterogenous and greater education among generalists may be warranted.

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