{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:17:58Z","timestamp":1791677878556,"version":"4.3.4"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec id=\"ab-noi230044-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Many disease-modifying therapies (DMTs) have been approved for multiple sclerosis (MS) in the past 2 decades. Research evaluating how these approvals have changed real-world prescribing patterns is scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230044-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate patterns in DMT initiations between 2001 and 2020 among commercially insured US adults and children with MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230044-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This serial cross-sectional study was conducted from 2001 through 2020 (mean patient enrollment duration, 4.8 years) and used US commercial claims data (MarketScan). Analysis took place between January 2022 and March 2023. Of 287\u202f084 patients with MS identified, 113\u202f583 patients (113\u202f095 adults and 488 children) with MS newly initiated at least 1 DMT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230044-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>New initiation episode of a DMT, defined as no claim for the same DMT in the previous year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230044-8\">\n                    <jats:title>Main Outcome Measure<\/jats:title>\n                    <jats:p>The proportion of total DMT initiations per year attributable to each DMT. Trends in initiations were evaluated annually.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230044-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study team identified 153\u202f846 DMT initiation episodes among adults (median age, 46 [IQR, 38-53) years]; 86\u202f133 female [76.2%]) and 583 among children (median age, 16 (IQR, 14-17) years; 346 female [70.9%]). Among adults, use of platform injectables showed an absolute decline of 73.8% over the study period, driven by a 61.2% reduction in interferon \u03b2 initiations (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001 for trend). In contrast, the 2010 introduction of oral DMTs led to a rise in their use from 1.1% (2010) to 62.3% (2020) of all DMT initiations (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.002 for trend). Infusion therapy initiations remained relatively low, accounting for 3.2% of all initiations since their introduction in 2004 but increased modestly annually after ocrelizumab was introduced (2017), reaching 8.2% of all initiations in 2020 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001 for trend). Children showed similar initiation patterns, except for preferred oral therapy. Between 2019 and 2020, dimethyl fumarate was the most commonly initiated DMT in adults (23.3% to 27.2% of all initiations), while in children fingolimod was the most commonly initiated (34.8% to 68.8%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi230044-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Current MS treatment guidelines emphasize shared decision-making between patients and clinicians to balance treatment efficacy, safety, cost, and convenience. This study found that oral DMTs were the predominant DMT type initiated by 2020. The cause of this shift cannot be determined from this study, but may reflect several factors, including convenience of administration, direct-to-consumer advertising, or insurance restrictions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2023.2125","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T11:31:24Z","timestamp":1688988684000},"page":"860","source":"Crossref","is-referenced-by-count":41,"title":["Initiation Patterns of Disease-Modifying Therapies for Multiple Sclerosis Among US Adults and Children, 2001 Through 2020"],"prefix":"10.1001","volume":"80","author":[{"given":"Mackenzie","family":"Henderson","sequence":"first","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Horton","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey"},{"name":"Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey"},{"name":"Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram","family":"Bhise","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey"},{"name":"Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian","family":"Pal","sequence":"additional","affiliation":[{"name":"Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Bushnell","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey"},{"name":"Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chintan V.","family":"Dave","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"noi230044r2","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1517\/14740338.2015.1093620","article-title":"Risk of progressive multifocal leukoencephalopathy in patients with multiple sclerosis.","volume":"14","author":"Faulkner","year":"2015","journal-title":"Expert Opin Drug Saf"},{"issue":"17","key":"noi230044r3","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.1056\/NEJMoa0802670","article-title":"Alemtuzumab vs interferon beta-1a in early multiple sclerosis.","volume":"359","author":"Coles","year":"2008","journal-title":"N Engl J Med"},{"issue":"3","key":"noi230044r4","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1056\/NEJMoa1601277","article-title":"Ocrelizumab versus interferon beta-1a in relapsing multiple sclerosis.","volume":"376","author":"Hauser","year":"2017","journal-title":"N Engl J Med"},{"issue":"11","key":"noi230044r5","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/S1474-4422(19)30238-8","article-title":"Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (RADIANCE): a multicentre, randomised, 24-month, phase 3 trial.","volume":"18","author":"Cohen","year":"2019","journal-title":"Lancet Neurol"},{"issue":"11","key":"noi230044r6","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1016\/S1474-4422(19)30239-X","article-title":"Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial.","volume":"18","author":"Comi","year":"2019","journal-title":"Lancet Neurol"},{"issue":"17","key":"noi230044r7","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1212\/WNL.0000000000005347","article-title":"Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology.","volume":"90","author":"Rae-Grant","year":"2018","journal-title":"Neurology"},{"issue":"7","key":"noi230044r8","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s11940-021-00677-1","article-title":"Early aggressive treatment approaches for multiple sclerosis.","volume":"23","author":"Simpson","year":"2021","journal-title":"Curr Treat Options Neurol"},{"issue":"5","key":"noi230044r9","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1001\/jamaneurol.2018.4905","article-title":"Clinical outcomes of escalation vs early intensive disease-modifying therapy in patients with multiple sclerosis.","volume":"76","author":"Harding","year":"2019","journal-title":"JAMA Neurol"},{"issue":"4","key":"noi230044r10","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S1474-4422(20)30067-3","article-title":"Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study.","volume":"19","author":"He","year":"2020","journal-title":"Lancet Neurol"},{"issue":"1","key":"noi230044r11","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/vaccines9010012","article-title":"Safety of newer disease modifying therapies in multiple sclerosis.","volume":"9","author":"Jalkh","year":"2020","journal-title":"Vaccines (Basel)"},{"issue":"3","key":"noi230044r12","doi-asserted-by":"publisher","first-page":"101","DOI":"10.7224\/1537-2073.2019-095","article-title":"Utilization and treatment patterns of disease-modifying therapy in pediatric patients with multiple sclerosis in the United States.","volume":"23","author":"Greenberg","year":"2021","journal-title":"Int J MS Care"},{"issue":"10","key":"noi230044r13","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1016\/j.clinthera.2013.07.330","article-title":"Treatment patterns in disease-modifying therapy for patients with multiple sclerosis in the United States.","volume":"35","author":"Bonafede","year":"2013","journal-title":"Clin Ther"},{"issue":"7","key":"noi230044r14","doi-asserted-by":"publisher","first-page":"3163","DOI":"10.1007\/s12325-020-01367-1","article-title":"Treatment patterns among patients with multiple sclerosis initiating second-line disease-modifying therapy.","volume":"37","author":"Bowen","year":"2020","journal-title":"Adv Ther"},{"issue":"11","key":"noi230044r15","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1016\/j.clinthera.2020.09.014","article-title":"Treatment patterns and relapses among newly treated multiple sclerosis patients from a retrospective claims analysis.","volume":"42","author":"Kantor","year":"2020","journal-title":"Clin Ther"},{"key":"noi230044r16","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102260","article-title":"Epidemiology of pediatric multiple sclerosis: a systematic literature review and meta-analysis.","volume":"44","author":"Yan","year":"2020","journal-title":"Mult Scler Relat Disord"},{"issue":"8","key":"noi230044r17","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"5","key":"noi230044r19","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1185\/03007995.2015.1014029","article-title":"Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis.","volume":"31","author":"Capkun","year":"2015","journal-title":"Curr Med Res Opin"},{"issue":"3","key":"noi230044r20","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3111\/13696998.2013.764309","article-title":"Treatment patterns in multiple sclerosis: administrative claims analysis over 10 years.","volume":"16","author":"Oleen-Burkey","year":"2013","journal-title":"J Med Econ"},{"key":"noi230044r24","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.058404","article-title":"Natalizumab and progressive multifocal leucoencephalopathy.","author":"Berger","year":"2006","journal-title":"Ann Rheum Dis"},{"issue":"5","key":"noi230044r25","doi-asserted-by":"publisher","first-page":"940","DOI":"10.3390\/ijms18050940","article-title":"Natalizumab in multiple sclerosis: long-term management.","volume":"18","author":"Clerico","year":"2017","journal-title":"Int J Mol Sci"},{"key":"noi230044r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2021.577721","article-title":"Disease-modifying therapies and progressive multifocal leukoencephalopathy in multiple sclerosis: a systematic review and meta-analysis.","volume":"360","author":"Sriwastava","year":"2021","journal-title":"J Neuroimmunol"},{"key":"noi230044r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.101459","article-title":"Consensus recommendations for the diagnosis and treatment of multiple sclerosis: 2019 revisions to the MENACTRIMS guidelines.","volume":"37","author":"Yamout","year":"2020","journal-title":"Mult Scler Relat Disord"},{"issue":"11","key":"noi230044r28","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1056\/NEJMoa1800149","article-title":"Trial of fingolimod versus interferon beta-1a in pediatric multiple sclerosis.","volume":"379","author":"Chitnis","year":"2018","journal-title":"N Engl J Med"},{"issue":"9","key":"noi230044r30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.30439","article-title":"Effect of dimethyl fumarate vs interferon \u00df-1a in patients with pediatric-onset multiple sclerosis: the CONNECT randomized clinical trial.","volume":"5","author":"Vermersch","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"5","key":"noi230044r31","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1002\/phar.v41.5","article-title":"Comparative treatment effectiveness of oral fingolimod and conventional injectable disease-modifying agents in multiple sclerosis.","volume":"41","author":"Earla","year":"2021","journal-title":"Pharmacotherapy"},{"issue":"10","key":"noi230044r32","doi-asserted-by":"publisher","first-page":"e1029","DOI":"10.1212\/WNL.0000000000007035","article-title":"The prevalence of MS in the United States: a population-based estimate using health claims data.","volume":"92","author":"Wallin","year":"2019","journal-title":"Neurology"},{"key":"noi230044r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2020.106203","article-title":"Impact of coronavirus disease (COVID-19) pandemic on multiple sclerosis care.","volume":"197","author":"Salama","year":"2020","journal-title":"Clin Neurol Neurosurg"},{"key":"noi230044r1","unstructured":"National Multiple Sclerosis Society. Disease-modifying therapies for MS. Accessed May 31, 2023. https:\/\/www.nationalmssociety.org\/For-Professionals\/Clinical-Care\/Managing-MS\/Disease-Modification"},{"key":"noi230044r18","unstructured":"IBM Watson Health. IBM MarketScan research databases for life sciences researchers. Accessed June 5, 2023. https:\/\/www.ibm.com\/downloads\/cas\/0NKLE57Y"},{"key":"noi230044r21","unstructured":"United States Census Bureau. United States population growth by region. Accessed May 31, 2023. https:\/\/www.census.gov\/popclock\/data_tables.php?component=growth"},{"key":"noi230044r22","unstructured":"US Food and Drug Administration. Gilenya (fingolimod) (package insert). Accessed May 31, 2023. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2019\/022527s031lbl.pdf"},{"key":"noi230044r23","unstructured":"US Food and Drug Administration. Copaxone (glatiramer) (package insert). Accessed May 31, 2023. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2009\/020622s057lbl.pdf"},{"key":"noi230044r29","unstructured":"US Food and Drug Administration. FDA expands approval of Gilenya to treat multiple sclerosis in pediatric patients. Accessed May 31, 2023. https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-expands-approval-gilenya-treat-multiple-sclerosis-pediatric-patients"}],"container-title":["JAMA Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/articlepdf\/2806620\/jamaneurology_henderson_2023_oi_230044_1691786970.31375.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T11:01:42Z","timestamp":1692010902000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2806620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":33,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaneurol.2023.2125","relation":{},"ISSN":["2168-6149"],"issn-type":[{"value":"2168-6149","type":"print"}],"subject":[],"published":{"date-parts":[[2023,8,1]]}}}