STOCKHOLM — A high percentage of neurologists report diagnosing secondary progressive multiple sclerosis (SPMS) over a shorter period than that suggested by clinical guidance, and a greater number of neurologists who focus on multiple sclerosis (MS) diagnose and treat patients with SPMS than general neurologists, according to research results presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held September 11-13, 2019 in Stockholm, Sweden.
The researchers performed a cross-sectional survey of 300 board-certified general and MS-specialized neurologists in the United States. The survey asked both academic and community physicians how they diagnosed SPMS in patients who had transitioned to the disease in the past year. Respondents were also asked about the importance of clinical indicators and other variables that influenced their treatment approach. Researchers further summarized responses based on physician specialty and practice setting.
The respondent pool was comprised mostly of general neurologists (63%), with 59% of these coming from private practice. Approximately two-thirds of physicians responded with the belief that SPMS is a distinct phenotype. Neurologists specialized in MS treated a greater number of patients with SPMS than general neurologists (mean ± SD, 76±82 vs 26±39, respectively). In 45% of respondents, a patient’s clinical history from the prior year was considered the most important indicator for SPMS diagnosis. Findings on magnetic resonance imaging were ranked the least important indicator of SPMS.
Additional variables that influenced diagnosis of SPMS by 53%, 21%, and 20% included worsening daily function, patient-reported worsening functions/symptoms, and worsening gait, respectively. One of the top indicators for SPMS was declining ambulation. More than 50% of respondents reported using neurologic exams, patient history in the prior year, patient self-report of symptoms/decline, magnetic resonance imaging, and gait assessment to validate a diagnosis of SPMS.
Study limitations include the cross-sectional nature of the analysis, as well as the use of a survey for data collection.
The researchers concluded that “physicians rely on patient history to diagnose SPMS, and many consider diagnosing SPMS over a shorter period (3 to 6 months) than suggested by clinical guidance (1 year).” As a result, the researchers believe “physicians may be recognizing SPMS early, which may allow for earlier consideration of treatment options to delay progression.” The study investigators warn that while SPMS may be interpreted as a distinct phenotype, continued education and diagnosis is warranted.
Vollmer T, Alvarez E, Nair K. Physicians’ perspectives on the identification and diagnosis of secondary progressive multiple sclerosis during the clinical encounter. Abstract presented at: 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; September 11-13, 2019; Stockholm, Sweden.