Patients with secondary progressive multiple sclerosis (SPMS) are less likely to be treated with disease modifying therapies (DMTs) when compared to patients with relapsing remitting multiple sclerosis (RRMS), according to a review of treatment patterns presented at the 37^th Congress of the European Committee for Treatment and Research in Multiple Sclerosis.

“Clinical classification is a clear acknowledgement that a progression has occurred whereas with OA  (objective algorithm) it is unclear whether the clinical team are aware of a transition in disease phenotype or due to local guidance may not acknowledge this formally,” said Professor Richard Nicholas, consultant neurologist, Imperial College Healthcare NHS Trust, London, United Kingdom, and co-researchers. “Given most disease modifying therapies (DMTs) are licensed for RRMS we assessed the rates of DMT use in those with clinical RRMS and SPMS and those classified as OA-SPMS or OA-RRMS.”

Researchers sought to assess treatment patterns for patients with RRMS and SPMS in Czechia, Denmark, Germany, Sweden, and the UK to compare phenotype assessments and an objective decision tree (DT) classifier.

Data from the years 2004 to 2020 were collected from MS registries in all 5 countries, with each country being treated as a separate study. A total of 52849 participants had clinical RRMS and 11386 participants had SPMS. Multiple odds-ratio random effects model meta-analysis of treatment were performed for each country.

“RRMS and SPMS patients were classified with the objective classifier and grouped by clinical phenotype (classified phenotype). Groups included were SPMS including DT-SPMS(RR) and DT-SPMS(SP) and RRMS including DT-RRMS(RR), DT-RRMS(SP),” Professor Nicholas said.

Each participant was treated with the DMT used at their most recent visit.

Researchers found patients with RRMS were more likely to be treated with DMTs than SPMS. Patients clinically diagnosed  with RRMS with characteristics of SPMS, determined by the objective classifier, were less likely to be treated. Patients with clinical SPMS and the characteristics of RRMS were more likely to be treated.

Rodgers, J, Watt, J, et al. Treatment patterns in secondary progressive multiple sclerosis a multi-country registry study from five European countries. Presented at: The 37^th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; October 13-15, 2021. Presentation: P008.