Understanding the Patient's Journey in the Diagnosis and Treatment of Multiple Sclerosis in Clinical Practice.

PURPOSE: The aim of this study was to describe the treatment journey of patients with multiple sclerosis (MS).

METHODS: This study was conducted in 2 phases. The first consisted of a claims-based analysis of data from patients diagnosed with MS between October 1, 2010, and May 31, 2014. Study patients were aged ≥18 years, had ≥12 months of continuous eligibility before and after the earliest MS diagnosis (index date), ≥1 disease-modifying therapy (DMT) claim postindex, and no claims with a code for DMT or MS during the 12-month preindex period. The second phase consisted of medical record reviews in a subset of patients in the claims study who had ≥1 neurologist visit within 90 days of the index MS diagnosis.

FINDINGS: A total of 1639 patients were selected for claims-based analysis, and medical record analysis was conducted in a subset of 327 of those patients. The mean age in both samples was 42 years; females constituted about 70% of each group. Medical records showed that within a year of the first neurologist visit, 97.6% patients had a confirmed MS diagnosis; however, in 58.0%, MS type was not specified. MS symptoms were documented in less than half of all patients at the index neurologist visit. Early management consisted of magnetic resonance imaging (98.5% of patients), and the management of flares (annualized relapse rate, 0.3 [0.6] per patient). Use of spinal tap (21.7%), Expanded Disability Status Scale score (4.6%), and timed 25-foot walk score (8.6%) to evaluate disease progression was infrequent. The percentages of patients discontinuing the first DMT over time were high (43.1% among patients with 12-24 months of postindex follow-up, to 65.7% among patients with >36 months of postindex follow-up). Neurologists noted that about 10% of patients had difficulty adhering to an MS medication regimen, and documented several reasons for discontinuation, including adverse drug events and lack of desired effectiveness.

IMPLICATIONS: In clinical practice, early MS treatment in DMT users is focused on symptom management, irrespective of MS type. Patients may benefit from initiating optimal treatment earlier. First-line therapy was often a transient option.