Abstract Details

Title Patterns of Disease Modifying Therapy Utilization in Women with Multiple Sclerosis Before, During, and After Pregnancy

Topic Multiple Sclerosis

Presentation(s) P9 - Poster Session 9 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-016

Background Pregnancy is a common consideration for women with MS; MS onset is typically between the ages of 20-45 years, i.e., during the child-bearing years. Pregnancy and postpartum care are a significant factor influencing DMT selection for many patients with MS. To date, few DMTs are considered safe to continue during pregnancy and real-world treatment patterns before, during and after pregnancy remain uncharacterized.

Objective To evaluate disease-modifying therapy (DMT) utilization for the treatment of multiple sclerosis (MS) before, during and after pregnancy.

Design/Methods In this retrospective, observational study, the US MarketScan Commercial and Medicaid claims database was assessed for female patients aged 18-55 years, with an MS diagnosis and ≥1 delivery-related inpatient or outpatient claims from 01January2016-30April2021.

Results

A cohort of 944 patients was identified; 688 (73%) were commercially-insured and 256 (27%) received Medicaid. Prevalence of DMT use declined sharply during pregnancy, from 36.3% of patients in the 6 months prior to pregnancy (pre-pregnancy) to 17.9%, 5.3% and 5.8% in trimesters (T) 1, 2 and 3, respectively. Postpartum DMT utilization increased to 20.9% at 0–3 months and 24.4% at 4–6 months. Of all patients (n=944) in the pre-pregnancy period, the most frequently used DMTs were glatiramer acetate (15.0%), dimethyl fumarate (6.4%), interferon (5.4%) and natalizumab (5.2%). Of patients treated with any DMT in T1, patients were more likely to continue treatment into T3 if treated with natalizumab and glatiramer acetate (60.9% [T1] to 10.9% [T3] and 54.8% [T1] to 20.7% [T3], respectively) compared with interferon (36.7% [T1] to 8.2% [T3]), fingolimod (35.1% [T1] to 8.1% [T3]), dimethyl fumarate (28.1% [T1] to 7.0% [T3]), or ocrelizumab (6.7% [T1] to 0% [T3]).

Conclusions DMT utilization declined sharply during pregnancy; it gradually increased postpartum but remained below pre-pregnancy use. Infusibles administered every 6-12 months (e.g., anti-CD20 medications) may have been underestimated.

Authors/Disclosures
Anna Shah, MD (University of Colorado, Neurology Dept) PRESENTER	The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. The institution of Dr. Shah has received research support from Genentech/Roche. Dr. Shah has received personal compensation in the range of $5,000-$9,999 for serving as a Educational Speaker with Rocky Mountain MS Center.
Riley Bove, MD, FAAN (University of California, San Francisco)	Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for NeurologyLive. Dr. Bove has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bove has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen. The institution of Dr. Bove has received research support from Biogen. The institution of Dr. Bove has received research support from Roche Genentech. The institution of Dr. Bove has received research support from Novartis. The institution of Dr. Bove has received research support from Eli Lilly.
Angela Applebee, MD (St Peter'S MS Center)	Dr. Applebee has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Applebee has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Applebee has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genzyme. Dr. Applebee has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Serono. Dr. Applebee has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Horizon. Dr. Applebee has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb.
Katrina Bawden, NP (Rocky Mountain MS Clinic)	Ms. Bawden has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Ms. Bawden has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biohaven. Ms. Bawden has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Banner Life Sciences. Ms. Bawden has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG therapeutics.
Celeste Fine (Gilbert Neurology)	Ms. Fine has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Ms. Fine has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie.
Robin L. Avila, PhD (Biogen)	Mrs. Avila has received personal compensation for serving as an employee of Biogen. Mrs. Avila has stock in Biogen.
Nicholas Belviso, PhD, PharmD	Dr. Belviso has received personal compensation for serving as an employee of Biogen.
	No disclosure on file
Kinyee Fong (Biogen)	No disclosure on file
James B. Lewin, PharmD	Dr. Lewin has received personal compensation for serving as an employee of Biogen. Dr. Lewin has stock in Biogen.
	No disclosure on file
Sarah England, PhD (Biogen)	Dr. England has received personal compensation for serving as an employee of Biogen. Dr. England has stock in Biogen.
Megan Vignos, PhD (Biogen)	Dr. Vignos has stock in Biogen. Dr. Vignos has received personal compensation in the range of $100,000-$499,999 for serving as a Employee with Biogen.