Socio-economic status influences access to second-line disease modifying treatment in Relapsing Remitting Multiple Sclerosis patients

Floriane Calocer (1, 2) , Olivier Dejardin (1, 3) , Karine Droulon (4) , Guy Launoy (1, 3) , Gilles Defer (1, 2)

1 CHU Caen
2 PhIND - Physiopathologie et imagerie des troubles neurologiques
3 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
4 RBN-SEP - Réseau Bas-Normand pour la prise en charge de la SEP

OBJECTIVE: In MS, Socio-Economic status (SES) may influence healthcare and access to disease-modifying treatments (DMTs). Optimising delays to switch patients to a second-line DMT may hamper disease progression most effectively and achieve long term disease control. The objective of this study is to identify the influence of SES on the delay between first and second line DMT in RRMS patients, in Western-Normandy, France. METHODS: The association between SES and the delay to access a second-line DMT were studied using data from the MS registry of Western-Normandy including 733 patients with a diagnosis of RRMS during the period in question [1982-2011]. We used the European Deprivation Index (EDI), a score with a rank level inversely related to SES. We performed multivariate adjusted Cox models for studying EDI effect on the delay between first and second line DMT. RESULTS: No significant influence of SES was observed on delay to access a second-line DMT if first-line DMT exposure time was less than 5 years. After 5 years from initiation of first-line treatment the risk of accessing a second-line DMT is 3 times higher for patients with lower deprivation indices (1st quintile of EDI) ([HR] 3.14 95%CI [1.72-5.72], p-value<0.001) compared to patients with higher values (EDI quintiles 2 to 5). INTERPRETATION: In RRMS, a high SES may facilitate access to a second-line DMT a few years after first-line DMT exposure. Greater consideration should also be given to the SES of MS patients as a risk factor in therapeutic healthcare issues throughout medical follow-up.

Domaines: Santé publique et épidémiologie

Floriane Calocer, Olivier Dejardin, Karine Droulon, Guy Launoy, Gilles Defer. Socio-economic status influences access to second-line disease modifying treatment in Relapsing Remitting Multiple Sclerosis patients. PLoS ONE, 2018, 13 (2), pp.e0191646. ⟨10.1371/journal.pone.0191646⟩. ⟨inserm-01856017⟩