Fewer than 1 in 5 Patients Use Newer Drugs for Neurological Conditions

Only a small proportion of patients with neurological conditions are using newer medications recently approved by the US Food and Drug Administration (FDA), according to study results published online ahead of print in Neurology.

“Our study of people with neurologic conditions found fewer than 20% were being treated with new medications,” said study corresponding author Brian C. Callaghan, MD, University of Michigan Health in Ann Arbor. “For new, high-cost medications that have similar effectiveness to older drugs, limited use is likely appropriate. However, future studies are needed to look into whether the high costs are barriers to those new medications that can really make a difference for people living with neurologic disease.”

Medications that received FDA approval between 2014 and 2018 were considered new medications for study purposes.

The study included patients in a private insurance claims database diagnosed with 1 of 11 neurologic conditions and treated with a new or existing medication. Among them, 2.3 million people had migraine, 76,990 had multiple sclerosis (MS), 67,917 had Parkinson disease, 57,259 had orthostatic hypertension, 22,936 had myasthenia gravis, 6257 had tardive dyskinesia, 4180 had amyotrophic lateral sclerosis (ALS), 2277 had Huntington disease, 267 had transthyretin amyloidosis, 163 had Duchenne disease, and 10 had spinal muscular atrophy (SMA).

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Fewer than 20% of patients were taking new medications across all conditions except one, according to the study. Among patients with tardive dyskinesia, 32% were taking a new medication.

The study also found substantially higher out-of-pocket and total costs for new medications. In 2019, median out-of-pocket costs for a 30-day supply were highest for edaravone for ALS ($712.80) and eculizumab for myasthenia gravis ($91.10). On the whole, out-of-pocket costs were highly variable and unpredictable for new drugs compared with existing medications, researchers reported.

In patients with the rare diseases of spinal muscular atrophy and transthyretin amyloidosis, newer medications offer stabilization of otherwise progressive and debilitating conditions, Dr Callaghan pointed out.

“Unfortunately,” he said, “the small number of people in the study with these conditions did not allow the authors to make conclusions about the effect of cost on use of these game-changing medications.”

Reference

Reynolds EL, Gallagher G, Hill CE, Banerjee M, Mante A, Esper GJ, Callaghan BC. Costs and utilization of new-to-market neurologic medications. Neurology. Published online November 30, 2022. doi:10.1212/WNL.0000000000201627