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Practice patterns of US neurologists in patients with SPMS and PPMS: A consensus study
Omar Khan1, Aaron E Miller, Carlo Tornatore
1Wayne State University School of Medicine (OK), Detroit, MI; Mount Sinai School of Medicine (AEM), New York, NY; Georgetown University Hospital (CT), Washington, DC; Baylor Institute for Immunology Research (JTP), Dallas, TX; and Infusion Communications (CJB), Haddam, CT.
Abstract:
A modified Delphi process assessed current multiple sclerosis (MS) practice patterns for secondary and primary progressive MS (secondary progressive MS [SPMS] and primary progressive MS [PPMS]). In early 2011, 2 sequential, case-based surveys were administered to 75 US MS specialists to assess treatment practices and patient management. Respondents were from geographically diverse US academic (42%) and community (58%) treatment centers. There was consensus (≥75% agreement in responses) to switch disease-modifying therapies for a patient with SPMS with both MRI activity and disability progression (95%), but no consensus on treatment selection. For PPMS, responses supported diagnosis using spinal MRI (100%) and lumbar puncture (75%) and treatment initiation in patients with brain gadolinium-enhancing lesions with or without spinal cord lesions (85%); however, there was no consensus on treatment initiation with spinal cord lesions alone or initial therapy. The lack of agreement among US MS experts on the best treatment approaches for SPMS or PPMS highlights the need for effective therapies.
Insights
US Multiple Sclerosis (MS) specialists agree on switching therapies for SPMS with disease activity but lack consensus on treatment selection for SPMS and PPMS, indicating a need for new therapies.
Area of Science:
- Neurology
- Clinical Practice Guidelines
- Neuroimmunology
Background:
- Multiple Sclerosis (MS) practice patterns for progressive forms remain variable.
- Effective management strategies for secondary progressive MS (SPMS) and primary progressive MS (PPMS) are critical.
- Current treatment approaches may not fully address the complexities of progressive MS.
Purpose of the Study:
- To assess current US expert practice patterns for managing SPMS and PPMS.
- To identify areas of consensus and disagreement in the treatment of progressive MS.
- To highlight the need for evidence-based guidelines and novel therapies for SPMS and PPMS.
Main Methods:
- A modified Delphi process utilizing two sequential, case-based surveys.
- Surveys administered to 75 US Multiple Sclerosis (MS) specialists in early 2011.
- Respondents represented diverse academic and community treatment centers.
Main Results:
- Consensus (95%) exists to switch disease-modifying therapies for SPMS with MRI activity and progression, but not on specific treatment selection.
- Diagnosis of PPMS supported by spinal MRI (100%) and lumbar puncture (75%).
- Treatment initiation for PPMS supported with brain gadolinium-enhancing lesions (85%), but no consensus on spinal cord lesions alone or initial therapy.
Conclusions:
- Significant expert agreement exists for managing SPMS with active disease, but treatment choices lack consensus.
- Diagnostic criteria for PPMS show high agreement, yet treatment initiation and selection remain contentious.
- The identified lack of consensus underscores the urgent need for more effective therapies and standardized treatment protocols for SPMS and PPMS.
