Predictors of high- versus low-intensity first-line multiple sclerosis treatments.

Background: Disease-modifying therapies (DMTs) for multiple sclerosis (MS) can be either high- or low-intensity. This study aims to examine predictors associated with high-intensity MS treatment strategies using commercial claims data. Methods: We used Merative MarketScan commercial and Medicare supplemental databases to examine patients with: outpatient MS diagnosis (ICD-9/-10: 340.xx, G35.xx); DMT fill; no DMTs 1 year prior to MS diagnosis through DMT fill; and 6 months continuous database enrollment. The first DMT filled was classified as either high- (natalizumab, alemtuzumab, ocrelizumab, rituximab, ofatumumab, cladribine) or low-intensity (interferon, glatiramer acetate, teriflunomide, dimethyl fumarate, diroximel fumarate, fingolimod, ponesimod, siponimod, ozanimod). We used logistic regression to examine factors associated with high-intensity first-line MS treatments, and multilevel modelling to characterize provider-level variance. Results: A total of 16,405 patients met the study criteria, and they were 48 years old on average (SD = 12), and 75% female. High-intensity first-line DMT was used in 3%, increasing from <1% in 2012 to 13% in 2021. Provider type was most commonly neurologist (49%) or MS specialist (36%). Provider-level effect accounted for 17% of variance. Discussion: The minority of MS patients initiated high-intensity treatment although this proportion increased over time, and later years were predictive of high-intensity treatment. Providers had a significant role in the approach selected.