Multiple Sclerosis: Therapy Recommendations and Treatment Advances The MS treatment landscape has been centered around disease-modifying therapies (DMTs), with more novel agents, biosimilars, bioequivalents, and generics coming to further saturate the market. Multiple sclerosis (MS) is a chronic autoimmune inflammatory demyelinating disease of the central nervous system (CNS) with a largely unknown etiology.1 The clinical course begins with an immune-mediated attack on the CNS that leads to demyelination via destruction of oligodendrocytes, then degeneration of axons.1 Activation of both T-lymphocytes and B-lymphocytes are believed to be involved in the inflammation and damage that occurs within the CNS. Research suggests that the risk of developing MS is determined by genetic as well as environmental components,1 which may include low vitamin D levels, a history of Epstein-Barr virus, ultraviolet light exposure, and cigarette smoking.1 Currently, an estimated nearly one million people in the U.S. live with MS. Women are three times more likely than men to receive a diagnosis of MS.2 Sue Wilhelm, B.S.Pharm., BCPS Director of Pharmacy Security Health Plan
Patients diagnosed with MS are classified into two core phenotypes: relapsing-remitting and progressive disease. Patients are then further classified into four clinical subtypes: • Clinically isolated syndrome (CIS). A CIS is the first clinical episode suggestive of an MS diagnosis.3 Patients with a CIS may or may not be diagnosed with MS at a later point in time.3 • Relapsing-remitting MS (RRMS). Accounting for approximately 85% of initial MS diagnoses, RRMS is the most common disease course and is defined by periods of attacks or relapses followed by periods of recovery or remission.3 • Primary progressive MS (PPMS). Approximately 15% of MS patients are diagnosed with PPMS, characterized by progression or worsening of neurologic function from the disease onset without periods of relapse and remission.3 • Secondary progressive MS (SPMS). SPMS is a progressive course with worsening neurologic function that follows an initially relapsing-remitting course.3 Most patients diagnosed with RRMS will progress to SPMS.
18 | Magellan Rx Report | Spring 2020
