Early use of high-efficacy therapies in multiple sclerosis in the United States: benefits, barriers, and strategies for encouraging adoption

Abstract

Multiple sclerosis (MS) is characterized by progressive neuroinflammation and neurodegeneration from disease onset that, if left untreated, can result in the accumulation of irreversible neurological disability. Early intervention with high-efficacy therapies (HETs) is increasingly recognized as the best strategy to delay or mitigate disease progression from the earliest stages of the disease and to prevent long-term neurodegeneration. Although there is growing clinical and real-world evidence supporting early HET intervention, foregoing this strategy in favor of a traditional escalation approach prioritizing lower-efficacy disease-modifying therapies remains a common approach in clinical practice. This review explores potential health care professional- and patient-related barriers to the early use of HETs in patients with MS in the United States. Barriers can include regulatory and reimbursement restrictions; knowledge gaps and long-term safety concerns among health care professionals; and various individual, cultural, and societal factors affecting patients. Potential strategies for overcoming these barriers and encouraging early HET use are proposed.

Decisional Conflict Regarding Disease-Modifying Treatment Choices Among Patients with Mid-Stage Relapsing-Remitting Multiple Sclerosis

“… 1–3 The MS therapeutic landscape has changed considerably in recent years with different treatment options capable of controlling the relapse rate and reducing the risk of disability progression. 4 , 5 However, many patients still suffer from a variety of disabling symptoms such as fatigue, sphincter disturbances, cognitive problems or pain. 2 , 6 Furthermore, despite our increasing understanding of numerous prognostic factors, the disease’s natural course varies, often making it challenging for neurologists to reliably predict their patients’ long-term prognosis.…”

“…Selecting an appropriate disease-modifying treatment (DMTs) for MS presents numerous challenges. 1 , 5 The expanding repertoire of available therapies, each characterized by its unique efficacy, safety considerations, and method of administration, complicates the decision-making process. 1 , 8 In addition, patient preferences play a crucial role in decision-making, as MS patients often have unique experiences and priorities that can significantly influence their treatment choices.…”