Current and Future Directions in MS Management: Key Considerations for Managed Care Pharmacists

BACKGROUND: The management paradigm for multiple sclerosis (MS) continues to evolve and is shifting toward earlier diagnosis, differentiation of patients with varying clinical prognoses, and earlier initiation of treatment in selected individuals. Based on surveys conducted at the 2008 annual conference of the Academy of Managed Care Pharmacy (AMCP) and at regional meetings held in 2009, several topics were identified for which pharmacists indicated a need for new and updated information. OBJECTIVES: To review (a) recent insights into the pathophysiology underlying MS, (b) the improvements in identification of patients with a clinically isolated syndrome (CIS) who will progress to clinically definite MS (CDMS), (c) the current role of magnetic resonance imaging (MRI) and other technologies in the diagnosis and ongoing management of MS, (d) the optimal time to initiate treatment in patients with CIS or MS, and (e) the potential utility of new and emerging therapies in MS management. METHODS: The medical education company PRIME conducted an educational need assessment regarding knowledge of recent developments and future directions in MS management at a symposium held at the Academy of Managed Care Pharmacy Educational Conference in Kansas City, Missouri, on October 17, 2008. This was augmented by an ongoing educational needs assessment initiative that involved a national series of regional dinner meetings for managed care pharmacists on the topic of MS in the first 3 quarters of 2009. Collectively, these needs assessments were designed to determine educational gaps that existed after participants attended the symposia on MS, in an effort to plan a follow-up enduring educational activity that addressed those gaps. Measures of learners post-program intent were collected, as well as specific topic areas recommended for a follow-up activity. SUMMARY: Advances have been made in the understanding of CIS subtypes and refinement of MS diagnostic criteria. Early initiation of treatment in patients with a CIS has been shown to prolong the time to progression to CDMS, delay the development of disability, and may also decrease long term health care costs. In addition, a number of novel therapies for patients with MS are in late stages of clinical development, including several oral medications that are of particular interest to managed care pharmacists. These will provide potentially attractive treatment alternatives for patients with MS, who currently must choose from a selection of injectable drugs.