European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), September 18, 2024 — A recent study has uncovered significant therapeutic inertia in the treatment of women with multiple sclerosis (MS), shedding light on gender disparities that may adversely affect long-term health outcomes for women of childbearing age. The findings were presented at the ECTRIMS 2024 conference.
The research indicates that concerns related to pregnancy contribute to the delayed or reduced use of disease-modifying treatments (DMTs) among women, even before pregnancy is considered. An analysis of 22,657 patients with relapsing MS—of whom 74.2% were women—utilizing the French MS registry (OFSEP) revealed that, over a median follow-up of 11.6 years, women had a significantly lower likelihood of being treated with any DMT (odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.87-0.97). Furthermore, their chances of being prescribed high-efficacy DMTs (HEDMTs) were even lower (OR = 0.80, 95% CI 0.74-0.86).
The study detailed variations in DMT usage across different treatments and over time. Notably, teriflunomide, fingolimod, and anti-CD20 therapies were consistently underutilized among women (ORs of 0.87, 0.78, and 0.80, respectively). While interferon and natalizumab were initially prescribed less frequently, their usage among women equalized over time (ORs of 0.99 and 0.96, respectively). Conversely, glatiramer acetate and dimethyl fumarate were initially prescribed equally to both genders but became more common among women later in the study (ORs of 1.27 and 1.17, respectively).
The research identified that the disparity in DMT usage emerged after two years of disease duration for all DMTs and as early as one year for HEDMTs. Notably, this gender-based treatment gap did not significantly vary with patient age, suggesting that therapeutic inertia persists regardless of a woman’s life stage.
These findings highlight the urgent need to reassess treatment decision-making for women with MS, particularly those of childbearing age. Concerns about pregnancy risks often lead to women not receiving the most effective therapies at the appropriate times. “The use of DMTs and HEDMTs is frequently limited by potential and unknown risks associated with pregnancy, especially given the lack of sufficient data when these drugs first enter the market,” said Professor Sandra Vukusic, the study’s lead author.
Both neurologists and patients contribute to this therapeutic inertia, with many opting for a cautious approach that avoids these treatments. “Neurologists may hesitate to prescribe DMTs, particularly if they are uncertain about managing pregnancy-related issues,” Professor Vukusic explained. “At the same time, women understandably want to minimize any risks to their child or pregnancy, with primary concerns including congenital malformations, fetal loss, and fetal growth disorders. Women may also feel uncomfortable if their neurologist appears uncertain.”
Looking ahead, the research team intends to further explore the factors contributing to this therapeutic inertia, aiming to enhance treatment strategies that prioritize both the long-term health of women with MS and their reproductive goals.
“The main consequence of this inertia is less effective control of disease activity during periods without DMTs, leading to the accumulation of lesions and a heightened risk of long-term disability,” emphasized Professor Vukusic. “This represents a significant missed opportunity for women, especially in an era when DMTs are highly effective when initiated early.”
To combat these challenges, the team advocates for a comprehensive approach: “Empowering patients through education, improving the dissemination of recent findings, providing formal training for specialists, and actively collecting and analyzing real-world data are crucial steps to reducing therapeutic inertia and ensuring equitable treatment,” Professor Vukusic concluded.
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