Nicholas Richard, Rodgers Jeff, Witts James, Lerede Annalaura, Friede Tim, Hillert Jan, Forsberg Lars, Glaser Anna, Manouchehrinia Ali, Ramanujam Ryan, Spelman Tim, Klyve Pernilla, Drahota Jiri, Horakova Dana, Joensen Hanna, Pontieri Luigi, Magyari Melinda, Ellenberger David, Stahmann Alexander, Butzkueven Helmut, Van Der Walt Anneke, Bezlyak Vladimir, Lines Carol, Middleton Rod
Swansea University Medical School, Swansea, UK.
Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK.
Ther Adv Neurol Disord. 2023 Sep 26;16:17562864231198963. doi: 10.1177/17562864231198963. eCollection 2023.
Prescribing guidance for disease-modifying treatment (DMT) in multiple sclerosis (MS) is centred on a clinical diagnosis of relapsing-remitting MS (RRMS). DMT prescription guidelines and monitoring vary across countries. Standardising the approach to diagnosis of disease course, for example, assigning RRMS or secondary progressive MS (SPMS) diagnoses, allows examination of the impact of health system characteristics on the stated clinical diagnosis and treatment access.
We analysed registry data from six cohorts in five countries (Czech Republic, Denmark, Germany, Sweden and United Kingdom) on patients with an initial diagnosis of RRMS. We standardised our approach utilising a pre-existing algorithm (DecisionTree, DT) to determine patient diagnoses of RRMS or secondary progressive MS (SPMS). We identified five global drivers of DMT prescribing: Provision, Availability, Funding, Monitoring and Audit, data were analysed against these concepts using meta-analysis and univariate meta-regression.
In 64,235 patients, we found variations in DMT use between countries, with higher usage in RRMS and lower usage in SPMS, with correspondingly lower usage in the UK compared to other registers. Factors such as female gender ( = 0.041), increasing disability via Expanded Disability Status Scale (EDSS) score ( = 0.004), and the presence of monitoring ( = 0.029) in SPMS influenced the likelihood of receiving DMTs. Standardising the diagnosis revealed differences in reclassification rates from clinical RRMS to DT-SPMS, with Sweden having the lowest rate Sweden (Sweden 0.009, range: Denmark 0.103 - UK portal 0.311). Those with higher EDSS at index ( < 0.03) and female gender ( < 0.049) were more likely to be reclassified from RRMS to DT-SPMS. The study also explored the impact of diagnosis on DMT usage in clinical SPMS, finding that the prescribing environment and auditing practices affected access to treatment.
This highlights the importance of a healthcare system's approach to verifying the clinical label of MS course in facilitating appropriate prescribing, with some flexibility allowed in uncertain cases to ensure continued access to treatment.
多发性硬化症（MS）疾病修正治疗（DMT）的处方指南以复发缓解型MS（RRMS）的临床诊断为核心。各国的DMT处方指南和监测方法各不相同。对疾病病程诊断方法进行标准化，例如确定RRMS或继发进展型MS（SPMS）的诊断，有助于考察卫生系统特征对既定临床诊断和治疗可及性的影响。
我们分析了来自五个国家（捷克共和国、丹麦、德国、瑞典和英国）六个队列的登记数据，这些队列中的患者最初被诊断为RRMS。我们利用一种预先存在的算法（决策树，DT）来标准化我们的方法，以确定患者的RRMS或继发进展型MS（SPMS）诊断。我们确定了DMT处方的五个全球驱动因素：供应、可及性、资金、监测和审计，使用荟萃分析和单变量荟萃回归针对这些概念对数据进行了分析。
在64235名患者中，我们发现各国之间DMT的使用存在差异，RRMS中的使用较高，SPMS中的使用较低，与其他登记处相比，英国的使用相应较低。女性性别（=0.041）、通过扩展残疾状态量表（EDSS）评分导致的残疾增加（=0.004）以及SPMS中存在监测（=0.029）等因素影响了接受DMT治疗的可能性。标准化诊断显示从临床RRMS重新分类为DT-SPMS的比率存在差异，瑞典的比率最低（瑞典0.009，范围：丹麦0.103 - 英国门户0.311）。索引时EDSS较高（<0.03）和女性性别（<0.049）的患者更有可能从RRMS重新分类为DT-SPMS。该研究还探讨了诊断对临床SPMS中DMT使用的影响，发现处方环境和审计实践会影响治疗的可及性。
这凸显了医疗保健系统在核实MS病程临床标签以促进适当处方方面的方法的重要性，在不确定的情况下允许一定的灵活性以确保持续获得治疗。
Zotero 插件
