Equal Access to DMTs for Everyone
The MS Coalition*, a group made up of the leading MS Organizations in the United States, released a new position paper in March, regarding the treatment of MS with Disease Modifying Therapies. This review takes a look at the use of DMTs in a variety of scenarios, such as age of onset, or when to change or discontinue a DMT.
You can access The Use of Disease-Modifying Therapies in Multiple Sclerosis: Principles and Current Evidence in its entirety online, and it makes for some interesting reading.
There were many noteworthy points in the updated report and here are a few of what jump off the page to me:
- No matter what age, a person who presents with relapsing MS should be offered the option to take a DMT. This applies to pediatric to geriatric patients.
- A DMT should be offered to a person with progressive disease if that person experiences relapses or has inflammation from their MS.
- Treatment with DMTs should not be discontinued, even if a person appears to be stable with their MS.
- Changes in the type of DMT being used should be made only if the person is not responding to the first DMT.
There is an additional section on access to treatment, which covers several points, the most significant one being each person with MS should have access to all of the approved DMTs and not just the ones selected by their payer (insurance). The reasoning for this recommendation is not everyone responds well to each of the drugs and there needs to be options for how the clinician will treat a person to find the most efficacious drug for the individual.
The committee clearly discusses how non-responders must have the flexibility in treatment to try other options. The same with people who begin their MS with aggressive disease and might want to begin their treatment with a more potent and aggressive DMT. Currently many payers require a person to have failed one or two of the lesser potent drugs before moving to a second level DMT. The committee notes that African-Americans tend to have a more active form of MS and may benefit from starting DMTs at the higher level drugs, and that option should be made readily available.
Interesting to me, they also address the non-compliant patient, those people who do not stick to their DMT for whatever reason and clearly state that the reason for non-adherence should be further understood by the clinician. The report suggests that perhaps there is a way to guide the person back to taking a DMT through counseling, finding financial assistance, or changing to a DMT that is more acceptable to the person taking it, such as an oral pill vs an injection. The bottom line was they recommend the clinic staff find out why a person stops adhering to treatment and if there might be a solution.
Sadly, these are just recommendations and hold no real weight with clinicians or the payers, many of whom may continue to administer DMTs in the same way they have always practiced. As this document becomes more widely circulated, we can only hope the approaches recommended that DMTs be made available to everyone as a choice for slowing MS progression will be adopted by everyone.
Wishing you well,
*The current members of the MS Coalition include Accelerated Cure, Can Do Multiple Sclerosis, Consortium of Multiple Sclerosis Centers, International Organization of Multiple Sclerosis Nurses, Multiple Sclerosis Association of America, Multiple Sclerosis Foundation, National Multiple Sclerosis Society and United Spinal Association. The Coalition was formed in 2005 to further use and share the limited resources available for MS.
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