Improving MS Outcomes Through Individualized Care

A presentation at the NAMCP 2018 Spring Managed Care Forum outlined how individualized care can improve multiple sclerosis (MS) outcomes and highlighted how value-based strategies can mitigate costs among these patients.

According to the presentation, MS is a chronic autoimmune demyelinating disease that results inflammatory and degenerative changes. The disease disproportionately affects females at a 3:1 ratio.

Lily Jung Henson, MD, chief medical officer at Piedmont Henry Hospital, started her presentation by discussing how leading MS treatments work, which treatments are the most effective, and the safety profiles for these therapies. She explained that current treatments include injectable disease modifying therapies (DMTs), oral DMTs, and intravenous DMTs. These drugs offer a significant reduction in relapsing-remitting MS over 2 years. 

Dr Henson also highlighted a number of emerging treatments including siponimod (Novartis), an oral, once-daily DMT that reduced risk of 6 month confirmed disability progression by 26% and annualized relapse rates 55.5%, according to the EXPAND clinical trial results. However, siponimod has a significant adverse event profile, including lymphopenia and seizures.

Another emerging treatment option highlighted by Dr Henson included autologous hematopoietic stem cell transplantation. This process involves the collection of stem cells through filtration of blood and the transplantation of hematopoietic stem cells back to reset the immune system. She cited data from the European Committee For Treatment and Research of MS that showed benefit among a small cohort of patients who failed two prior MS therapies. 

Dr Henson also showed data for the emerging therapy cladribine (EMD Serono), which showed that patients taking cladribine had a 4.46 increase in no evidence of disease activity compared with patients taking placebo. Clabribine patients were also less likely to have new relapses or lesion. 

According to Dr Henson’s presentation, high-dose biotin is another MS treatment currently in phase 3 trials. She said that biotin shows promise because the drug is safe and available through compounding pharmacies. 

Some DMTs are more cost-effective than others. Dr Henson highlighted a study that showed that natalizumab, dimethyl fumarate and peginterferon beta-1a are more cost-effective compared with fingolimod, glatiramer acetate, and subcutaneous interferon beta-1a. Ten-year treatment costs for these drugs ranged from $561,177 to $616,251.

“Actual impact on a particular plan will vary based on drug pricing and other factors affecting drug cost accrual,” she said.

Dr Henson also outlined new recommendations released by the American Academy of Neurology in 2018. These included recommendations for starting patients on DMTs, switching patients from one DMT to another, and ceasing treatment with DMTs.

—David Costill