Therapy Selection, DMT Switching Patterns in Patients With MS

IV drip medicine in hospital
Presenting at CMSC 2022, researchers compared switch treatment patterns and therapy selection decisions between DMTs with anti-CD20 mechanism of action.

Treatment history and disease-modifying therapy (DMT) drivers have been shown to vary among patients with multiple sclerosis (MS) who recently were switched to different anti-CD20 agents, according to study results presented at the 2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held from June 1-4, in National Harbor, Maryland.

The researchers sought to compare switch treatment patterns and therapy selection decisions among DMTs with an anti-CD20 mechanism of action (MOA). A total of 233 US neurologists completed the survey and provided the necessary data. The analyses were focused on switching to ocrelizumab (n=144), ofatumumab (n=47), and branded or biosimilar rituximab (n=41).

A cross-sectional analysis of medical record data from patients with MS who had switched to a new DMT between January 28, 2021, and March 1, 2021, within the prior 3 months was conducted.

Overall, 65% of the switches to ocrelizumab and 63% of the switches to rituximab were from first-line DMTs. Switches to ofatumumab, in contrast, were typically from first-line or second-line DMTs (43% vs 49%, respectively).

Patients who were switched to rituximab often had been taking a generic DMT (29%) or interferon (29%). Approximately half of the switches to ocrelizumab were among participants who had been taking an oral DMT — most often dimethyl fumarate (23%) or fingolimod (15%). Those individuals switching to ofatumumab frequently had been taking other monoclonal antibodies (36%) — most often ocrelizumab (21%).

For each of the anti-CD20 DMTs, the desire for a high-efficacy agent (ocrelizumab: 57%; ofatumumab: 51%; rituximab: 56%) and the MOA of the agent (ocrelizumab: 54%; ofatumumab: 53%; rituximab: 44%) were key reasons for making the change.

With ocrelizumab, its unique indication for primary progressive MS played an important role in the choice of DMT (23%). Administration-type preference (40%), perception that a patient was highly compliant with medical instructions (36%), COVID-19 pandemic–appropriate option (9%), and starter kit availability (7%) were the main reasons for choosing ofatumumab as the DMT. Rituximab selection was impacted by physicians’ comfort/familiarity with the agent (36%), low patient cost (26%), payer preference (21%), and no or low monitoring requirement burden (21%).

If a patient’s current DMT had not been available at the time of prescribing, common alternative treatment options included other anti-CD20 agents (ocrelizumab: 41%; ofatumumab: 42%; rituximab: 33%). Among patients currently being treated with ofatumumab, the subcutaneous DMT was chosen instead of infused ocrelizumab,  because of better convenience (67%) and preferred administration method (44%). Rituximab was chosen instead of ocrelizumab because of expectations that the patient copay would be lower (62%) and there would be fewer managed care hassles (46%).

The researchers concluded that among the anti-CD20 agents evaluated, “[ofatumumab] is more likely to be used later line compared with [ocrelizumab] and among patients where the once-monthly subcutaneous dosing profile was influential in the switch decision. [Branded or biosimilar rituximab], used off label for the treatment of MS, was used in place of [ocrelizumab] when market access was a concern” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference 

McFadden E, Schobel VR. Treatment patterns and therapy selection drivers comparison between anti-CD20 agent among patients with multiple sclerosis who recently switched disease-modifying therapy. Presented at: CMSC 2022 Annual Meeting; June 1-4, 2022; National Harbor, Maryland. Abstract DMT26.