Les DMT en France

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When we look at the DMT prescribed it seems that the use of platform agents are the most common, so the message of “Time is brain” is still not the Hymn sheet we are singing from

Leblanc S, Lefort M, Le Page E, Michel L, Leray E. Trends in disease-modifying therapy use in patients with multiple sclerosis using a 10-year population-based cohort study in France. Expert Rev Neurother. 2022. doi: 10.1080/14737175.2022.2061950.

Background: The availability of new disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) provides an opportunity for improving outcomes but makes disease management more complex. Our study aimed to describe changes in therapeutic practices over the period 2009-2018 and measure the impact of the arrival of oral DMTs on the use of injectable DMTs.

Methods: Data were extracted from a representative 1/97 sample of the French population covered by the healthcare insurance system. Study period was set from 1 January 2009 to 31 December 2018. Four periods of MS identification were defined (before 2009, 2009-2011, 2012-2015 and 2016-2018).

Results: Overall, 1,508 patients with MS were included, of whom 876 (58.1%) were treated at least once over the study period. Untreated patients were older and had more comorbidities than treated ones. First-line DMTs were the most frequent initial DMT (78.5%) and a shift has operated from injectable to oral drugs over time. The proportion of patients receiving several DMTs increased with the number of available drugs. End 2018, beta interferon, glatiramer acetate, teriflunomide, dimethylfumarate, fingolimod and natalizumab shared nearly equal parts.

Conclusions: This study provides valuable insights into the real-world use of DMTs and changes that have operated over time.

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5 comments

  • Could this be attributable in any way to language, the fact that so much research information is disseminated in English? That the closer any national scientific community is to speaking/interpreting English, the faster the information flow? I’m no expert but I’m guessing that a culture of recognising English as part of the toolkit for international scientific collaboration is more embedded in China than in France.

    • I don’t think the French scientists/clinicians read less English than the Chinese, but I don’t have evidence either way. Significant use of injectable platform DMTs is ongoing, including in the UK & US.

    • I doubt clinical prescribing has a lot to do with what languages the doctors were trained with. Oral drugs dominate Chinese MS prescriptions due to government health insurance coverage, patient’s preferences (very poorly informed) and doctor-farma relations. (Right now Norvatis dominates the market and most ppl are putting on imods.

  • I’m not sure that were any of the prescribers dx’d with MS they’d opt for an injectable. Indeed, it would be a more interesting study if the prescribers were asked how they’d want to be treated were they unfortunate enough to be dx’d.

    Once a baseline for each (anonymised, obvs) individual was established it’d be illuminating to do a gap analysis to see how their prescribing for others differed from what they’d want for themselves.

    I’ll bet @ProfG isn’t the only one who’d want to go straight to aHSCT the moment a Dx was confirmed.

  • I was asked to trial Rebif while living in France in 2005. I didn’t as I thought it involved a lot of faff. Don’t regret it though.

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