New Brunswick, NJ—Over the last few years, the mode of treatment for most U.S. patients with multiple sclerosis (MS) has shifted.

Now, according to a new study, the majority of MS patients treat the chronic and progressive neurological disorder with oral medications instead of injections. That likely occurred because of several factors, including convenience, consumer advertising, and approval by health insurers, according to Rutgers University researchers.

“While two injectable therapies known as platform injectables, were once the mainstay of multiple sclerosis treatment, our study showed oral therapies became the predominate treatment for multiple sclerosis by 2020,” said lead author Mackenzie Henderson, PharmD, a postdoctoral researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research. “Our investigation offers an important step in understanding the evolving treatment landscape for MS among U.S. adults and children.”

The report in Journal of the American Medical Association Neurology asked if the increasing availability of disease-modifying therapies (DMTs) for multiple sclerosis changed real-world prescribing patterns from 2001 through 2020.

The cross-sectional study of 153,846 adults and 583 children found that platform-injectable therapies were most commonly initiated early in the study period. “However, their use declined after 2010 with the introduction of oral agents, which became the most frequently initiated therapies by 2020; infusion therapy initiations remained low overall (less than 5%),” the researchers wrote.

The study had a mean patient enrollment duration of 4.8 years and used U.S. commercial claims data (MarketScan). The analysis took place between January 2022 and March 2023.

“Among adults, use of platform injectables showed an absolute decline of 73.8% over the study period, driven by a 61.2% reduction in interferon β initiations (P <.001 for trend),” the authors report. “In contrast, the 2010 introduction of oral DMTs led to a rise in their use from 1.1% (2010) to 62.3% (2020) of all DMT initiations (P = .002 for trend).”

The study noted that infusion therapy initiations remained relatively low, accounting for 3.2% of all initiations since their introduction in 2004, but increased modestly annually after ocrelizumab was introduced in 2017. Those reached 8.2% of all initiations in 2020.

Children showed similar initiation patterns, except for preferred oral therapy, the researchers advised. “Between 2019 and 2020, dimethyl fumarate was the most commonly initiated DMT in adults (23.3% to 27.2% of all initiations), while in children fingolimod was the most commonly initiated (34.8% to 68.8%),” the researchers added.

“Current MS treatment guidelines emphasize shared decision-making between patients and clinicians to balance treatment efficacy, safety, cost, and convenience,” the authors concluded. “This study found that oral DMTs were the predominant DMT type initiated by 2020. The cause of this shift cannot be determined from this study, but may reflect several factors, including convenience of administration, direct-to-consumer advertising, or insurance restrictions.”

Background information in the study describes how more than 10 new DMTS have been FDA-approved in the past 2 decades for MS treatment. “Specifically, oral DMTs became available in 2010 and have provided an alternative, more convenient form of administration compared with injectable and infusion therapies. As available treatment options for managing MS increase, treatment decisions revolve around shared decision-making between patients and clinicians regarding the need to balance convenience, safety and tolerability, efficacy, and costs,” the researchers advised.

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