Discontinuing disease-modifying therapy in progressive multiple sclerosis: can we stop what we have started?

Hdl Handle:
http://hdl.handle.net/10147/207576
Title:
Discontinuing disease-modifying therapy in progressive multiple sclerosis: can we stop what we have started?
Authors:
Lonergan, Roisin; Kinsella, Katie; Duggan, Marguerite; Jordan, Sinead; Hutchinson, Michael; Tubridy, Niall
Affiliation:
St Vincent's University Hospital, Neurology, Dublin, Republic of Ireland., roisin.lonergan@st-vincents.ie
Citation:
Mult Scler. 2009 Dec;15(12):1528-31. Epub 2009 Dec 7.
Journal:
Multiple sclerosis (Houndmills, Basingstoke, England)
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207576
DOI:
10.1177/1352458509351730
PubMed ID:
19995848
Abstract:
Disease-modifying therapy is ineffective in disabled patients (Expanded Disability Status Scale [EDSS] > 6.5) with secondary progressive multiple sclerosis (MS) without relapses, or in primary progressive MS. Many patients with secondary progressive MS who initially had relapsing MS continue to use disease-modifying therapies. The enormous associated costs are a burden to health services. Regular assessment is recommended to guide discontinuation of disease-modifying therapies when no longer beneficial, but this is unavailable to many patients, particularly in rural areas. The objectives of this study are as follows: 1. To observe use of disease-modifying therapies in patients with progressive multiple sclerosis and EDSS > 6.5. 2. To examine approaches used by a group of international MS experts to stopping-disease modifying therapies in patients with secondary progressive MS without relapses. During an epidemiological study in three regions of Ireland (southeast Dublin city, and Wexford and Donegal Counties), we recorded details of disease-modifying therapies in patients with progressive MS and EDSS > 6.5. An e-questionnaire was sent to 26 neurologists with expert knowledge of MS, asking them to share their approach to stopping disease-modifying therapies in patients with secondary progressive MS. Three hundred and thirty-six patients were studied: 88 from southeast Dublin, 99 from Wexford and 149 from Donegal. Forty-four had EDSS > 6.5: 12 were still using disease-modifying therapies. Of the surveyed neurologists, 15 made efforts to stop disease-modifying therapies in progressive multiple sclerosis, but most did not insist. A significant proportion (12 of 44 patients with progressive MS and EDSS > 6.5) was considered to be receiving therapy without benefit. Eleven of the 12 were from rural counties, reflecting poorer access to neurology services. The costs of disease-modifying therapies in this group (>170,000 euro yearly) could be re-directed towards development of neurology services to optimize their management.
Language:
eng
MeSH:
Adult; Cost Savings; Cost-Benefit Analysis; Disability Evaluation; Drug Administration Schedule; Drug Costs; Guideline Adherence; Humans; Immunosuppressive Agents/*administration & dosage/economics; Ireland/epidemiology; Medical Futility; Middle Aged; Multiple Sclerosis, Chronic Progressive/diagnosis/*drug; therapy/economics/epidemiology; *Neurology/economics; *Physician's Practice Patterns/economics; Practice Guidelines as Topic; Questionnaires; Rural Health Services; Severity of Illness Index; Treatment Failure; Urban Health Services
ISSN:
1477-0970 (Electronic); 1352-4585 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorLonergan, Roisinen_GB
dc.contributor.authorKinsella, Katieen_GB
dc.contributor.authorDuggan, Margueriteen_GB
dc.contributor.authorJordan, Sineaden_GB
dc.contributor.authorHutchinson, Michaelen_GB
dc.contributor.authorTubridy, Niallen_GB
dc.date.accessioned2012-02-01T10:31:50Z-
dc.date.available2012-02-01T10:31:50Z-
dc.date.issued2012-02-01T10:31:50Z-
dc.identifier.citationMult Scler. 2009 Dec;15(12):1528-31. Epub 2009 Dec 7.en_GB
dc.identifier.issn1477-0970 (Electronic)en_GB
dc.identifier.issn1352-4585 (Linking)en_GB
dc.identifier.pmid19995848en_GB
dc.identifier.doi10.1177/1352458509351730en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207576-
dc.description.abstractDisease-modifying therapy is ineffective in disabled patients (Expanded Disability Status Scale [EDSS] > 6.5) with secondary progressive multiple sclerosis (MS) without relapses, or in primary progressive MS. Many patients with secondary progressive MS who initially had relapsing MS continue to use disease-modifying therapies. The enormous associated costs are a burden to health services. Regular assessment is recommended to guide discontinuation of disease-modifying therapies when no longer beneficial, but this is unavailable to many patients, particularly in rural areas. The objectives of this study are as follows: 1. To observe use of disease-modifying therapies in patients with progressive multiple sclerosis and EDSS > 6.5. 2. To examine approaches used by a group of international MS experts to stopping-disease modifying therapies in patients with secondary progressive MS without relapses. During an epidemiological study in three regions of Ireland (southeast Dublin city, and Wexford and Donegal Counties), we recorded details of disease-modifying therapies in patients with progressive MS and EDSS > 6.5. An e-questionnaire was sent to 26 neurologists with expert knowledge of MS, asking them to share their approach to stopping disease-modifying therapies in patients with secondary progressive MS. Three hundred and thirty-six patients were studied: 88 from southeast Dublin, 99 from Wexford and 149 from Donegal. Forty-four had EDSS > 6.5: 12 were still using disease-modifying therapies. Of the surveyed neurologists, 15 made efforts to stop disease-modifying therapies in progressive multiple sclerosis, but most did not insist. A significant proportion (12 of 44 patients with progressive MS and EDSS > 6.5) was considered to be receiving therapy without benefit. Eleven of the 12 were from rural counties, reflecting poorer access to neurology services. The costs of disease-modifying therapies in this group (>170,000 euro yearly) could be re-directed towards development of neurology services to optimize their management.en_GB
dc.language.isoengen_GB
dc.subject.meshAdulten_GB
dc.subject.meshCost Savingsen_GB
dc.subject.meshCost-Benefit Analysisen_GB
dc.subject.meshDisability Evaluationen_GB
dc.subject.meshDrug Administration Scheduleen_GB
dc.subject.meshDrug Costsen_GB
dc.subject.meshGuideline Adherenceen_GB
dc.subject.meshHumansen_GB
dc.subject.meshImmunosuppressive Agents/*administration & dosage/economicsen_GB
dc.subject.meshIreland/epidemiologyen_GB
dc.subject.meshMedical Futilityen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshMultiple Sclerosis, Chronic Progressive/diagnosis/*drugen_GB
dc.subject.meshtherapy/economics/epidemiologyen_GB
dc.subject.mesh*Neurology/economicsen_GB
dc.subject.mesh*Physician's Practice Patterns/economicsen_GB
dc.subject.meshPractice Guidelines as Topicen_GB
dc.subject.meshQuestionnairesen_GB
dc.subject.meshRural Health Servicesen_GB
dc.subject.meshSeverity of Illness Indexen_GB
dc.subject.meshTreatment Failureen_GB
dc.subject.meshUrban Health Servicesen_GB
dc.titleDiscontinuing disease-modifying therapy in progressive multiple sclerosis: can we stop what we have started?en_GB
dc.contributor.departmentSt Vincent's University Hospital, Neurology, Dublin, Republic of Ireland., roisin.lonergan@st-vincents.ieen_GB
dc.identifier.journalMultiple sclerosis (Houndmills, Basingstoke, England)en_GB
dc.description.provinceLeinster-

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