A recent study presented at ECTRIMS 2024 reveals significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), raising concerns about gender disparities that may affect long-term health outcomes for women of childbearing age. The research indicates that apprehensions surrounding pregnancy often lead to delays or reduced usage of disease-modifying treatments (DMTs), even prior to pregnancy considerations.
Analyzing data from 22,657 patients with relapsing MS—74.2% of whom were women—registered in the French MS registry (OFSEP), the researchers found that women were significantly less likely to receive DMTs (OR=0.92) and high-efficacy DMTs (HEDMTs) (OR=0.80) over a median follow-up of 11.6 years. The disparity in DMT usage varied by treatment; teriflunomide, fingolimod, and anti-CD20 therapies were consistently underutilized (ORs 0.87, 0.78, and 0.80, respectively), while interferon and natalizumab showed equal usage over time. In contrast, glatiramer acetate and dimethyl fumarate started with equal gender distribution but later favored women (ORs 1.27 and 1.17, respectively).
The study highlighted that this treatment gap emerged after two years of disease duration for DMTs and as early as one year for HEDMTs, with no significant variation by patient age, suggesting that therapeutic inertia is persistent across different life stages.
Both neurologists and patients contribute to this inertia; neurologists may hesitate to prescribe DMTs due to uncertainty regarding pregnancy management, while women often prioritize concerns about risks to their pregnancies. “Women understandably avoid risks related to congenital malformations and fetal health,” explains Professor Vukusic.
The research team aims to delve deeper into the factors behind this therapeutic inertia, focusing on strategies that align with the long-term health of women with MS and their reproductive aspirations. “The impact of this inertia is diminished disease control during DMT-free periods, increasing long-term disability risks,” emphasizes Professor Vukusic.
To mitigate these challenges, the team advocates for a comprehensive approach: empowering patients through education, enhancing the dissemination of new findings, providing formal training for specialists, and actively collecting real-world data to reduce therapeutic inertia and ensure equitable treatment.
