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

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    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
    Issue Date
    2012-02-01T10:31:50Z
    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
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    Citation
    Mult Scler. 2009 Dec;15(12):1528-31. Epub 2009 Dec 7.
    Journal
    Multiple sclerosis (Houndmills, Basingstoke, England)
    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
    ISSN
    1477-0970 (Electronic)
    1352-4585 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1177/1352458509351730
    Scopus Count
    Collections
    St. Vincent's University Hospital

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