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Abstract Details

Evolving Diagnosis and Treatment of Secondary Progressive Multiple Sclerosis in the United States
Multiple Sclerosis
P5 - Poster Session 5 (8:00 AM-9:00 AM)
9-007

Evaluate how US Neurologists are diagnosing secondary progressive (SP) multiple sclerosis (MS) over time. Determine how treatment choices for SPMS are evolving.
In 2019, the FDA changed the prescribing information to include active SPMS for siponimod, in addition to natalizumab, ocrelizumab, cladribine, fingolimod, dimethyl fumarate, interferons, and glatiramer acetate.
US Neurologists contributed online chart reviews for a cross-sectional audit of patients with SPMS in Q3 2018 (n=168 physicians; 431 SPMS patients) and Q3 2019 (n=147 physicians; 423 SPMS patients).
SPMS transition was diagnosed most commonly by a progressive accumulation of disability independent of relapse activity (57% of patients). SPMS diagnosis in 2019 relied more upon confirmed disability progression (CDP) over 6 months (25% vs. 16% in 2018) and increased rate of brain atrophy (15% vs. 9%). Neurologists relied less upon absence of relapses (12% vs. 24% in 2018), length of time since MS diagnosis (11% vs. 16%), and a decreased annualized relapse rate (6% vs. 11%). In 2019, MS Specialists (n=85) were more likely to identify SPMS by CDP-6M (33% vs. 14%), whereas General Neurologists (n=61) relied more on worsening MRI findings (50% vs. 30%) and decreased walking speed (26% vs. 14%).  Compared to the prior year, the proportion with active SPMS increased (66% vs. 57%), with MS Specialists more likely to categorize SPMS patients active compared to General Neurologists (73% vs. 59%). SPMS patients were most likely to be treated with an oral DMT (34%), followed closely by monoclonal antibodies (32%). Siponimod and cladribine use was introduced in 2019, while fingolimod and dimethyl fumarate use declined from 2018 levels. 
US Neurologists continue to evolve in diagnosing SPMS, using the active SPMS subtype, and in treatment choices. 
Authors/Disclosures
Robert T. Naismith, MD, FÂ鶹´«Ã½Ó³»­ (Washington University)
PRESENTER 		Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Naismith has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squib. Dr. Naismith has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Naismith has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Genzyme. Dr. Naismith has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celltrion. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Naismith has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impaact-Bio. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyverna. Dr. Naismith has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon. Dr. Naismith has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch.
Jennifer Robinson No disclosure on file
Virginia Schobel Virginia Schobel has nothing to disclose.