Pediatric MS Remains Undertreated

SEATTLE — Many pediatric patients with multiple sclerosis (MS) are undertreated, according to an analysis of administrative insurance claims data in the U.S. presented here.

Of 288 newly diagnosed pediatric MS patients, 65.3% did not receive any disease modifying treatment (DMT) in the first year after their diagnosis, reported Benjamin Greenberg, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues.

Moreover, the overall proportion of untreated pediatric MS patients was around 40% or more each year from 2010 to 2017, reported co-author Chinmay Deshpande, PhD, of Novartis Pharmaceuticals in East Hanover, New Jersey, in a platform presentation at the Consortium of Multiple Sclerosis Centers annual meeting.

These results are not surprising, said Ann Yeh, MD, of the Hospital for Sick Children in Toronto, Canada, who was not involved with the research.

“There are a lot of pediatric patients who aren’t getting treated, and it’s a source of concern for us as physicians,” Yeh told MedPage Today. “It often takes families 6 months to a year to make the decision to start treatment.”

“It’s very challenging for teenagers to accept that they have an MS diagnosis,” she added. “Injectable drugs leave marks that are embarrassing. Girls like to wear short-shorts and expose their midriffs and with the injectables, that’s not going to happen.”

Pediatric MS occurs in approximately 3% to 5% of all MS patients, at a median onset age of 15. In this retrospective observational study, researchers studied pediatric patients who received at least two MS diagnoses from 2010 to 2016 in Truven Health MarketScan Commercial and Encounters databases, classifying the first MS diagnosis date as the index date. Patients were ages ≤17 years on their index diagnosis date and had continuous medical and pharmacy benefits 6 month before and 12 months after the index date.

The median age in the study was 13.9. In the first year after diagnosis, 34.7% of pediatric patients were treated with DMTs and 65.3% were not. Patients who received DMTs in the first year were an average of 15; those who did not receive treatment were an average age of 13.3. Most (75%) patients treated in the first year were female.

Glatiramer acetate (Copaxone) at 48% and interferon at 30.8% were the most commonly used treatments. About 20% of first-line patients switched to second-line DMTs within the first 6 months of treatment. Most patients stopped their first-line treatment for ≥60 days within the first 10 months.

From 2010 to 2017, use of interferon and glatiramer acetate consistently decreased and oral and infusible DMTs increased. The proportion of pediatric patients untreated at any point in the study ranged from 39.4% to 48.1%, depending on the year.

The study had several limitations, Deshpande noted. The claims database used in the analysis did not include clinical characteristics like MRI findings or disability scores. Because the prevalence of pediatric MS is low, the sample size was small. Claims information is a proxy measure of medication use and does not capture the reasons why patients discontinued or switched treatment, he added.