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098  Treatment escalation in secondary progressive MS identified clinically and algorithmically in relapsing remitting (RR)MS
  1. Richard Nicholas1,
  2. Rod Middleton2,
  3. James Witts2,
  4. William Rodgers2,
  5. Jan Hillert3,
  6. Alexander Stahmann4,
  7. Dana Horáková5,
  8. Melinda Magyari6,
  9. Carol Lines7,
  10. RCN SPMS Research Group8
  1. 1Department of Neurology, St Mary’s Hospital, Imperial College Healthcare
  2. 2Population Data Science, Swansea University
  3. 3Department of Clinical Neuroscience, Karolinska Institute, Stockholm
  4. 4German MS-Register, MS Forschungs- und Projektentwicklungs-gGmbH, Hanover
  5. 5Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague
  6. 6The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Denmark
  7. 7Novartis Pharma AG, Basel, Switzerland
  8. 8The Register Collaboration Network SPMS Research Group

Abstract

Introduction Objective algorithms (OA; Ramanujam, 2020) identify SPMS in those with clinically assigned (CA) RRMS, suggesting SPMS is under-diagnosed in practice. It’s unclear if clinicians are aware of this evolution and escalate therapy in response to clinical worsening with highly active (HA) disease modifying treatments (DMT).

Objective Assess whether treatment intensity escalates as the disease advances from RRMS to OA-SPMS and from RRMS to CA-SPMS.

Methods MS registries in Czech Republic, Denmark, Germany, Sweden and UK were used. Active DMTs at the date of last visit were classified as highly active (HA) or not, and DMT usage prior to CA-SPMS or OA-SPMS classification.

Results 3740 SPMS and 9542 OA-SPMS patients were on DMTs. HADMT use was 21.3% prior to OA-SPMS clas- sification in RRMS and 27.9% (p<0.0001) once classified. HADMT use was 23.5% prior to CA-SPMS diagnosis and 36.9% (p<0.0001) once diagnosed. HADMT use in the UK was lower than in other registries for all groups.

Conclusion Across Europe the evolution to clinical SPMS via OA-SPMS is eliciting a response from clini- cians that is not initially reflected in a change of diagnosis. Country variations in HADMT use in transitioning patients should be explored further.

r.m.middleton@swansea.ac.uk

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