Background: Disease-modifying therapy (DMT) has demonstrated benefits for patients in reducing relapse rates, disability progression, and new/enlarging MRI lesions. Most patients receive DMT from a specialty pharmacy and multiple studies have demonstrated the impact this care model can have on decreasing relapse rates and improving adherence. Physical and mental health symptoms can have a substantial impact on patient quality of life (QOL) and given the high-touch model of care specialty pharmacies provide it offers an opportunity to identify the impact MS has on patient reported outcomes.
Objectives: To demonstrate patient reported outcomes observed in patients receiving DMT through a specialty pharmacy MS program.
Methods: Patients receiving DMT through Ardon Health are enrolled in an MS patient management program which includes a baseline pharmacist assessment and reassessment every six months. Patients who completed a baseline assessment and at least one reassessment from the start of 2020 through June 30, 2021 were included. Clinical assessments cover many aspects such as adherence, tolerability, flare ups, and falls. Patients also complete a validated QOL assessment (SymptoMScreen) to monitor for worsening symptoms and ensure appropriate management strategies are in place. The screening tool uses a 7-point Likert scale that patients use to rate how 12 of the most common MS symptoms impact daily activities. The primary outcome was the number of patients with a worsening of at least two points in one or more domains on the SymptoMScreen compared to baseline. Secondary outcomes include patients reporting falls and concerns (side effects, efficacy, cost) with their DMT.
Results: Of patients who completed at least one baseline and reassessment 183/884 (20.7%) assessments identified patients who experienced worsening of at least 2 points in at least one symptom compared to their previous SymptoMScreen six months earlier. For the secondary outcome of falls, 8.7% of assessments identified patients with at least one fall in the previous 6 months. For concerns with therapy, 12.7% of assessments completed identified patients with DMT concerns.
Conclusions: This program at Ardon Health identifies how MS can impact patient QOL and provides opportunities for pharmacists to identify adherence or tolerability issues that may be contributing. Using this data pharmacists can collaborate with providers to help determine when changes in DMT or in a patients rehabilitation plan may be beneficial.