Fair and equitable treatment for multiple sclerosis in resource-poor regions: The need for off-label therapies and regional treatment guidelines

Pandit, Lekha

doi:10.1177/13524585211028806

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…However, the choice of treatment is still challenging, especially in the face of aggressive disease and severe financial restraints. [ 3 ] In these situations, subsidized care and support become necessary and health-care providers will need to be innovative and think out of the box. On one hand, they would need to retain the support and confidence of patients and their primary caregivers and on the other hand, they need to be innovative in finding care for them that is cost-effective.…”

Section: Discussionmentioning

confidence: 99%

“…In affluent countries, poor access to treatment is seen among economically deprived persons who are either unable to influence treatment decisions[ 1 ] or have health-care plans that are inadequate to include high-efficacy DMT. [ 2 ] In the low- and middle-income countries (LMICs), the cost of treatment is commonly met by “out-of-pocket” spending on cheaper and accessible off-label therapies (OLTs)[ 3 ] or generic versions of MS treatments. Off-label DMTs generally refer to treatments that have regulatory approval for another disease but are used to treat MS, often when there is limited access to mainstream (“on-label”) treatment options.…”

Section: Introductionmentioning

confidence: 99%

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Determining Effectiveness of “Off-Label Therapies” for Multiple Sclerosis in a Real-World Setting

Pandit,

Mustafa,

Sudhir

et al. 2024

Annals of Indian Academy of Neurology

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Objective: To determine the factors, if any, that are associated with the efficacy of “off-label therapies” (OLTs) for multiple sclerosis (MS). Methods: Consecutive patients (N = 174) with relapsing–remitting MS (RRMS) or secondary progressive MS (SPMS) with relapses, on OLTs with a generic formulation of azathioprine, mycophenolate mofetil, or rituximab biosimilar for ≥2 years were included. Annualized relapse rate (ARR) and expanded disability status score (EDSS) 1 year before and ≥2 years after starting OLTs were recorded. Optical coherence tomography (OCT) was done at baseline and at the end of the study. Results: During a median period of 4.1 years (2.4–24), ARR reduced in all (P < 0.0001) and EDSS improved in RRMS (P < 0.0001) patients but not in SPMS (P < 0.31) patients. Good responders were those who had RRMS (P = 0.001, odds ratio [OR] 0.04, 95% confidence interval [CI] 0.01–0.15), female gender (P 0.008, OR 6.67, 95% CI 1.7–26.8), and had early access to OLT (P = 0.006, OR 1.2, 95% CI 1.05–1.40). Baseline peripapillary retinal nerve fiber layer thickness identified the risk of conversion to SPMS (P < 0.01, OR 1.03; 95% CI 1.01–1.06). Conclusions: This limited prospective study suggests that early identification of patients who could potentially respond to unconventional but accessible therapies may be valuable in the treatment of MS, particularly in resource-poor regions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Determining Effectiveness of “Off-Label Therapies” for Multiple Sclerosis in a Real-World Setting

Pandit,

Mustafa,

Sudhir

et al. 2024

Annals of Indian Academy of Neurology

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“…Absolute lymphocyte counted reported within the previous 3 months to our registry and or at the time of COVID-19 infection was reviewed. Our registry patients had been advised to continue first line DMT (generic dimethyl fumerate [DMF], teriflunomide or beta interferon [IFN-β]) and nonspecific immunosuppressants (IS) namely generic versions of mycophenolate mofetil [MMF],Azathioprine [AZA] or rituximab[RTX] biosimilar ( Pandit, 2021 ). We encouraged all patients to get vaccinated while on DMT, MMF & AZA.…”

Section: Methodsmentioning

confidence: 99%

COVID-19 infection and vaccination against COVID-19: Impact on managing demyelinating CNS disorders in Southern India- experience from a demyelinating disease registry.

Pandit

Akshatha

Malli

et al. 2022

Multiple Sclerosis and Related Disorders

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“…Currently, India has a small insurance market. Approximately 15% of people have insurance, with the remaining 85% paying out of pocket [ 109 ].…”

Section: Diagnostic Challengesmentioning

confidence: 99%

Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges

Khan

Gupta

Mehan

2023

JCM

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Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system and can result in disability. Although the prevalence of MS has increased in India, diagnosis and treatment continue to be difficult due to several factors. The present study examines the difficulties in detecting and treating multiple sclerosis in India. A lack of MS knowledge among healthcare professionals and the general public, which delays diagnosis and treatment, is one of the significant issues. Inadequate numbers of neurologists and professionals with knowledge of MS management also exacerbate the situation. In addition, MS medications are expensive and not covered by insurance, making them inaccessible to most patients. Due to the absence of established treatment protocols and standards for MS care, India’s treatment techniques vary. In addition, India’s population diversity poses unique challenges regarding genetic variations, cellular and molecular abnormalities, and the potential for differing treatment responses. MS is more difficult to accurately diagnose and monitor due to a lack of specialized medical supplies and diagnostic instruments. Improved awareness and education among healthcare professionals and the general public, as well as the development of standardized treatment regimens and increased investment in MS research and infrastructure, are required to address these issues. By addressing these issues, it is anticipated that MS diagnosis and treatment in India will improve, leading to better outcomes for those affected by this chronic condition.

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Fair and equitable treatment for multiple sclerosis in resource-poor regions: The need for off-label therapies and regional treatment guidelines

Cited by 4 publications

References 13 publications

Determining Effectiveness of “Off-Label Therapies” for Multiple Sclerosis in a Real-World Setting

Determining Effectiveness of “Off-Label Therapies” for Multiple Sclerosis in a Real-World Setting

COVID-19 infection and vaccination against COVID-19: Impact on managing demyelinating CNS disorders in Southern India- experience from a demyelinating disease registry.

Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges

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