Hiding in plain sight: The magnitude of unused disease modifying therapies in multiple sclerosis and strategies for reducing the economic burden of care

Disability outcomes in early-stage African American and White people with multiple sclerosis

“…In our population we did not identified differences in current treatment distribution, but we cannot exclude that, along the disease course, differences in treatment choices related to access to specialized vs non-specialized MS care might have contributed to the observed gradient in disability. However, we did not identified differences in number of DMTs, and, despite a recent report identifying injection fatigue and subjective worsening as factors increasing the likelihood of therapy switch in African American pwMS (Okuda et al, 2022), no difference in treatment transition prior to study enrollment were present between African American and White pwMS.…”

Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities?

“…These are pertinent issues to keep in mind when pondering different clinical MS trajectories which could, in part, relate to persistence of staying on a specific DMT and the reasons why some pwMS may not stay on a prescribed DMT. Furthermore, the magnitude of DMT waste in this study was over one million dollars in 1 month, with the majority switching therapies for reasons other than inadequate disease control and intolerability ( 56 ). This raises the question of whether these DMTs being wasted could be used in populations who have inadequate access to DMTs due to difficulties with insurance coverage.…”

“…Furthermore, discontinuation of DMTs is an important factor to consider and reasons for this are diverse. One study showed that African Americans or other Black pwMS changed DMT due to injection fatigue (with desire for an oral medication) and subjective perceived lack of efficacy more frequently than White pwMS, but that they were less likely to switch DMT based on side effects ( 56 ). These are pertinent issues to keep in mind when pondering different clinical MS trajectories which could, in part, relate to persistence of staying on a specific DMT and the reasons why some pwMS may not stay on a prescribed DMT.…”

Radiologically isolated syndrome in the spectrum of multiple sclerosis

“…30 The practical clinical implications from these trials may result in an expansion of disease-modifying therapies prescribed by clinicians and advanced practice providers, potentially leading to a further rise in medical waste from premature discontinuations. 31 However, even before these clinical trial data were available, treated subjects were frequently encountered in many countries. 4 The basis for use is not entirely clear and may have been biased by the findings on MRI.…”