Prescription Patterns in Multiple Sclerosis Changing

Neurologists are prescribing more oral disease-modifying therapy (DMT) for initial treatment of multiple sclerosis (MS) than ever. Out of 1,018 individuals with multiple sclerosis (MS) in a 3-month period, close to half received an oral DMT as their first treatment. Only 4 years ago, the proportion of individuals receiving oral treatment was just over one-third. 
Neurologist now have multiple options for first-line treatment for individuals with MS such as ozanimod (Zeposia; Bristol Myers Squibb, Princeton, NJ) and diroximel fumarate (Vumerity; Biogen, Cambridge, MA). S1P receptor modulators are frequently considered optimal first-line choices for individuals with adverse prognoses. 
Dimethyl fumarates were the most commonly used DMT. Over the past year, the prescription of dimethyl and diroximel fumarate increased to 65%, in part because of  its high tolerability. For higher-efficacy treatments the S1P receptor modulator class is prescribed most often and has a lower rate of required first-dose observations. 

Within the next few years further expansion for mechanistic options within the oral DMT class is to be expected for the Bruton tyrosine kinase (BTK) inhibitors such as evobrutinib (M2951; EMD Serono, Rockland, MA), tolebrutinib (PRN2246; Sanofi Genzyme, Camobridge, MA), and fenebrutinib (GDC-0853; Genentech, South San Francisco, CA). If evobrutinib was available previously, 1 in 10 individuals without previous treatment in this study would be appropriate candidates for the treatment. Out of the 1,018 individuals involved in the data, the 102 individuals with primary progressive MS (PPMS) has a higher percentage of being a likely candidate for BTK inhibitors verses individuals with relapsing MS.
The data used for this review came from charts of 205 neurologists as part of the RealWorld Dynamix: DMT New Starts in Multiple Sclerosis (MS) service.