Physicians' perspectives on the identification and diagnosis of secondary progressive multiple sclerosis during the clinical encounter
ECTRIMS Online Library. Vollmer T. 09/13/19; 278292; P1090
Prof. Timothy Vollmer
Prof. Timothy Vollmer
Contributions
Abstract

Abstract: P1090

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis

T. Vollmer1, E. Alvarez1, K. Nair1, M. Gorritz2, H. Maloney2, Y. Ding2, T. Golan2, L. Bartolome3, R.L. Wade2, R. Kumar2, W. Su4, P. Russo4

1Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, 2IQVIA, Inc., Plymouth Meeting, 3Jefferson College of Population Health, Philadelphia, PA, 4Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States

Introduction: Secondary progressive multiple sclerosis (SPMS), which is distinct from primary progressive disease (PPMS), is defined as progressively worsening symptoms, independent of relapses, leading to accumulation of disability. As SPMS treatment options emerge, identifying the transition to SPMS will be critical to timely diagnosis. Information is sparse as to how physicians identify patients transitioning to SPMS.
Objectives: Identify clinical indicators that are important to neurologists in diagnosing SPMS.
Methods: A cross-sectional survey of 300 board-certified general and MS-focused neurologists in the United States was fielded. Academic and community physician respondents with experience managing patients that transitioned to SPMS in the past year were queried on how they diagnose SPMS, the importance of specific clinical indicators, and other factors influencing the treatment approach. Responses were summarized by physician specialty and by practice setting.
Results: Most respondents were general neurologists (63%); 59% from private practice. Two-thirds believe SPMS is a distinct phenotype. MS-focused neurologists reported treating three times as many SPMS patients as general neurologists (mean±SD:76±82 vs. 26±39). Clinical history in the prior year was the most important clinical indicator in diagnosing SPMS (45% of respondents); MRI findings ranked least important by 56% and most important by 15% of respondents. Worsening daily function, patient-reported worsening functions/symptoms and worsening gait were most often cited as additional criteria that influence the diagnosis of SPMS by 53%, 21%, and 20%, respectively. Declining ambulation emerged among the top five indicators for SPMS for over one third of physicians. Over half reported always using neurological exams, patient history in the prior year, patient self-report of symptoms/decline, MRI, and gait assessments to confirm a SPMS diagnosis. Most specified a 3-6-month interval over which a patient should demonstrate change to make the diagnosis.
Conclusions: Physicians rely on patient history to diagnose SPMS, and many consider diagnosing SPMS over a shorter period (3-6 months) than suggested by clinical guidance (1 year). This implies that physicians may be recognizing SPMS early, which may allow for earlier consideration of treatment options to delay progression. While most neurologists accept SPMS as a distinct phenotype, continued education about diagnosis of SPMS is warranted.
Disclosure: This study was sponsored by Novartis. Vollmer T, Alvarez E, and Nair K provide consulting services to Novartis. Gorritz M, Maloney H, Ding Y, Wade RL and Kumar R are employees of IQVIA which received consulting fees to conduct the study. Bartolome L is a postdoctoral research fellow at Novartis. Su W and Russo P are employees of Novartis.

Abstract: P1090

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis

T. Vollmer1, E. Alvarez1, K. Nair1, M. Gorritz2, H. Maloney2, Y. Ding2, T. Golan2, L. Bartolome3, R.L. Wade2, R. Kumar2, W. Su4, P. Russo4

1Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, 2IQVIA, Inc., Plymouth Meeting, 3Jefferson College of Population Health, Philadelphia, PA, 4Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States

Introduction: Secondary progressive multiple sclerosis (SPMS), which is distinct from primary progressive disease (PPMS), is defined as progressively worsening symptoms, independent of relapses, leading to accumulation of disability. As SPMS treatment options emerge, identifying the transition to SPMS will be critical to timely diagnosis. Information is sparse as to how physicians identify patients transitioning to SPMS.
Objectives: Identify clinical indicators that are important to neurologists in diagnosing SPMS.
Methods: A cross-sectional survey of 300 board-certified general and MS-focused neurologists in the United States was fielded. Academic and community physician respondents with experience managing patients that transitioned to SPMS in the past year were queried on how they diagnose SPMS, the importance of specific clinical indicators, and other factors influencing the treatment approach. Responses were summarized by physician specialty and by practice setting.
Results: Most respondents were general neurologists (63%); 59% from private practice. Two-thirds believe SPMS is a distinct phenotype. MS-focused neurologists reported treating three times as many SPMS patients as general neurologists (mean±SD:76±82 vs. 26±39). Clinical history in the prior year was the most important clinical indicator in diagnosing SPMS (45% of respondents); MRI findings ranked least important by 56% and most important by 15% of respondents. Worsening daily function, patient-reported worsening functions/symptoms and worsening gait were most often cited as additional criteria that influence the diagnosis of SPMS by 53%, 21%, and 20%, respectively. Declining ambulation emerged among the top five indicators for SPMS for over one third of physicians. Over half reported always using neurological exams, patient history in the prior year, patient self-report of symptoms/decline, MRI, and gait assessments to confirm a SPMS diagnosis. Most specified a 3-6-month interval over which a patient should demonstrate change to make the diagnosis.
Conclusions: Physicians rely on patient history to diagnose SPMS, and many consider diagnosing SPMS over a shorter period (3-6 months) than suggested by clinical guidance (1 year). This implies that physicians may be recognizing SPMS early, which may allow for earlier consideration of treatment options to delay progression. While most neurologists accept SPMS as a distinct phenotype, continued education about diagnosis of SPMS is warranted.
Disclosure: This study was sponsored by Novartis. Vollmer T, Alvarez E, and Nair K provide consulting services to Novartis. Gorritz M, Maloney H, Ding Y, Wade RL and Kumar R are employees of IQVIA which received consulting fees to conduct the study. Bartolome L is a postdoctoral research fellow at Novartis. Su W and Russo P are employees of Novartis.

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