Skip to main content
Top
Published in: BMC Medicine 1/2007

Open Access 01-12-2007 | Research article

Analysis of NAMCS data for multiple sclerosis, 1998–2004

Authors: Jagannadha R Avasarala, Cormac A O'Donovan, Steve E Roach, Fabian Camacho, Steven R Feldman

Published in: BMC Medicine | Issue 1/2007

Login to get access

Abstract

Background

To our knowledge, no study to date has investigated the prescribing patterns of immunomodulatory agents (IMAs) in an outpatient setting in the United States. To address this issue, we performed retrospective data analyses on National Ambulatory Medical Care Survey (NAMCS) data for MS patient visits between 1998 and 2004.

Methods

NAMCS data are a weighted estimate of the nationwide frequency of patients' outpatient clinic visits. We analyzed NAMCS data in the following categories: (1) the proportion of MS patient visits to neurologists, family practitioners or internists, (2) age/gender/race/geographical distribution patterns in patient visits, and (3) the proportion of patients on IMA treatment among established MS patients.

Results

There were an estimated 6.7 million multiple sclerosis (MS) patient visits to the clinics between 1998–2004. Neurologists recorded the most patient visits, 50.7%. Patient visits were mostly in the fourth and fifth decade age group (57.9%). The male to female ratio was 1:4. No statistical evidence was observed for a decline or increase in IMA usage. About 62% patients visiting neurologists and 92% seen by family practitioners/internists were not using IMAs. Our results suggest that between the years 1998–2003, the use of interferon-1a tended to decline while the use of interferon-1b and glatiramer acetate, increased.

Conclusion

Strategies that lead to improved use of IMAs in the management of MS in the outpatient setting are needed.
Appendix
Available only for authorised users
Literature
1.
go back to reference Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L: Axonal transection in the lesions of multiple sclerosis. N Engl J Med. 1998, 338: 278-85.CrossRefPubMed Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mork S, Bo L: Axonal transection in the lesions of multiple sclerosis. N Engl J Med. 1998, 338: 278-85.CrossRefPubMed
2.
go back to reference Vermersch P, de Seze J, Delisse B, Lemaire S, Stojkovic T: Quality of life in multiple sclerosis: influence of interferon-β1a (Avonex®) treatment. Mult Scler. 2002, 8: 377-81.CrossRefPubMed Vermersch P, de Seze J, Delisse B, Lemaire S, Stojkovic T: Quality of life in multiple sclerosis: influence of interferon-β1a (Avonex®) treatment. Mult Scler. 2002, 8: 377-81.CrossRefPubMed
4.
go back to reference Hader WJ, Elliot M, Ebers GC: Epidemiology of multiple sclerosis in London and Middlesex County, Ontario, Canada. Neurology. 1988, 38: 617-21.CrossRefPubMed Hader WJ, Elliot M, Ebers GC: Epidemiology of multiple sclerosis in London and Middlesex County, Ontario, Canada. Neurology. 1988, 38: 617-21.CrossRefPubMed
6.
go back to reference Sawcer S, Jones HB, Feakes R, Gray J, Smaldon N, Chataway J, et al: A genome screen in multiple sclerosis reveals susceptibility loci on chromosome 6p21 and 17q22. Nat Genet. 1996, 13: 464-68.CrossRefPubMed Sawcer S, Jones HB, Feakes R, Gray J, Smaldon N, Chataway J, et al: A genome screen in multiple sclerosis reveals susceptibility loci on chromosome 6p21 and 17q22. Nat Genet. 1996, 13: 464-68.CrossRefPubMed
7.
go back to reference Haines JL, Ter-Minassian M, Bazyk A, Gusella JF, Kim DJ, Terwedow H, PericakVance MA, Rimmler JB, Haynes CS, Roses AD, Lee A, Shaner B, Menold M, Seboun E, Fitoussi R-P, Gartioux C, Reyes C, Ribierre F, Gyapay G, Weissenbach J, Hauser SL, Goodkin DE, Lincoln R, Usuku K, Garcia-Merino A, Gatto N, Young S, Oksenberg JR: A complete genomic screen for multiple sclerosis underscores a role for the major histocompatibility complex: the Multiple Sclerosis Genetics Group. Nat Genet. 1996, 13: 469-71.CrossRefPubMed Haines JL, Ter-Minassian M, Bazyk A, Gusella JF, Kim DJ, Terwedow H, PericakVance MA, Rimmler JB, Haynes CS, Roses AD, Lee A, Shaner B, Menold M, Seboun E, Fitoussi R-P, Gartioux C, Reyes C, Ribierre F, Gyapay G, Weissenbach J, Hauser SL, Goodkin DE, Lincoln R, Usuku K, Garcia-Merino A, Gatto N, Young S, Oksenberg JR: A complete genomic screen for multiple sclerosis underscores a role for the major histocompatibility complex: the Multiple Sclerosis Genetics Group. Nat Genet. 1996, 13: 469-71.CrossRefPubMed
8.
go back to reference The IFNB Multiple Sclerosis Study Group: Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993, 43: 655-61.CrossRef The IFNB Multiple Sclerosis Study Group: Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993, 43: 655-61.CrossRef
9.
go back to reference Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, Fischer JS, Goodkin DE, Granger CV, Simon JH, Alam JJ, Bartoszak DM, Bourdette DN, Braiman J, Brownscheidle CM, Coats ME, Cohan SL, Dougherty DS, Kinkel RP, Mass MK, Munschauer FE, Priore RL, Pullicino PM, Scherokman BJ, Whitham RH: Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol. 1996, 39: 285-94.CrossRefPubMed Jacobs LD, Cookfair DL, Rudick RA, Herndon RM, Richert JR, Salazar AM, Fischer JS, Goodkin DE, Granger CV, Simon JH, Alam JJ, Bartoszak DM, Bourdette DN, Braiman J, Brownscheidle CM, Coats ME, Cohan SL, Dougherty DS, Kinkel RP, Mass MK, Munschauer FE, Priore RL, Pullicino PM, Scherokman BJ, Whitham RH: Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol. 1996, 39: 285-94.CrossRefPubMed
10.
go back to reference Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, Myers LW, Panitch HS, Rose JW, Schiffer RB: Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of phase III multicenter, double-blind, placebo-controlled trial. Neurology. 1995, 45: 1268-76.CrossRefPubMed Johnson KP, Brooks BR, Cohen JA, Ford CC, Goldstein J, Lisak RP, Myers LW, Panitch HS, Rose JW, Schiffer RB: Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of phase III multicenter, double-blind, placebo-controlled trial. Neurology. 1995, 45: 1268-76.CrossRefPubMed
11.
go back to reference PRISMS (Prevention of Relapses and disability by Interferon beta-1a Subcutaneously in MS) Study Group: Randomized, double-blind, placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet. 1998, 352: 1498-504.CrossRef PRISMS (Prevention of Relapses and disability by Interferon beta-1a Subcutaneously in MS) Study Group: Randomized, double-blind, placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet. 1998, 352: 1498-504.CrossRef
12.
go back to reference Flachenecker P, Rieckmann P: Early intervention in multiple sclerosis : better outcomes for patients and society?. Drugs. 2003, 63: 1525-33.CrossRefPubMed Flachenecker P, Rieckmann P: Early intervention in multiple sclerosis : better outcomes for patients and society?. Drugs. 2003, 63: 1525-33.CrossRefPubMed
13.
go back to reference Grima DT, Torrance GW, Francis G, Rice G, Rosner AJ, Lafortune L: Cost and health related quality of life consequences of multiple sclerosis. Mult Scler. 2000, 6: 91-8.CrossRefPubMed Grima DT, Torrance GW, Francis G, Rice G, Rosner AJ, Lafortune L: Cost and health related quality of life consequences of multiple sclerosis. Mult Scler. 2000, 6: 91-8.CrossRefPubMed
14.
go back to reference Namen AM, Dunagan DP, Fleischer A, Tillett J, Barnett M, McCall WV, Haponik EF: Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey. Chest. 2002, 121: 1741-47.CrossRefPubMed Namen AM, Dunagan DP, Fleischer A, Tillett J, Barnett M, McCall WV, Haponik EF: Increased physician-reported sleep apnea: the National Ambulatory Medical Care Survey. Chest. 2002, 121: 1741-47.CrossRefPubMed
15.
go back to reference Panitch H, Goodin DS, Francis G, Chang P, Coyle PK, O'Connor P, Monaghan E, Li D, Weinshenker B: Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial. Neurology. 2002, 59: 1496-506.CrossRefPubMed Panitch H, Goodin DS, Francis G, Chang P, Coyle PK, O'Connor P, Monaghan E, Li D, Weinshenker B: Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial. Neurology. 2002, 59: 1496-506.CrossRefPubMed
16.
go back to reference Durelli L, Verdun E, Barbero P, Bergui M, Versino E, Ghezzi A, Montanari E, Zaffaroni M: Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study (INCOMIN). Lancet. 2002, 359: 1453-60.CrossRefPubMed Durelli L, Verdun E, Barbero P, Bergui M, Versino E, Ghezzi A, Montanari E, Zaffaroni M: Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study (INCOMIN). Lancet. 2002, 359: 1453-60.CrossRefPubMed
17.
18.
go back to reference The IFNB Multiple Sclerosis Study Group: Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993, 43: 655-61.CrossRef The IFNB Multiple Sclerosis Study Group: Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology. 1993, 43: 655-61.CrossRef
19.
go back to reference IFNB Multiple Sclerosis Study Group and the University of British Columbia Ms/MRI Analysis Group: Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology. 1995, 45: 1277-85.CrossRef IFNB Multiple Sclerosis Study Group and the University of British Columbia Ms/MRI Analysis Group: Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology. 1995, 45: 1277-85.CrossRef
20.
go back to reference Rudick R, Fisher E, Lee JC, Simon J, Jacobs L: Use of the brain parenchymal fraction to measure whole brain atrophy in relapsing-remitting MS. Neurology. 1999, 53: 1698-703.CrossRefPubMed Rudick R, Fisher E, Lee JC, Simon J, Jacobs L: Use of the brain parenchymal fraction to measure whole brain atrophy in relapsing-remitting MS. Neurology. 1999, 53: 1698-703.CrossRefPubMed
21.
go back to reference Weinstock-Guttman B, Jacobs LD: What is new in the treatment of multiple sclerosis?. Drugs. 2000, 59: 401-10.CrossRefPubMed Weinstock-Guttman B, Jacobs LD: What is new in the treatment of multiple sclerosis?. Drugs. 2000, 59: 401-10.CrossRefPubMed
22.
go back to reference Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownscheidle CM, Murray TJ, Simonian NA, Slasor PJ, Sandrock AW: Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000, 343: 898-904.CrossRefPubMed Jacobs LD, Beck RW, Simon JH, Kinkel RP, Brownscheidle CM, Murray TJ, Simonian NA, Slasor PJ, Sandrock AW: Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. N Engl J Med. 2000, 343: 898-904.CrossRefPubMed
23.
go back to reference Comi G, Filippi M, Barkhof F, Durelli L, Edan G, Fernandez O, Hartung H, Seeldrayers P, Sorensen PS, Rovaris M, Martinelli V, Hommes OR, Early Treatment of Multiple Sclerosis Study Group: Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet. 2001, 357: 1576-82.CrossRefPubMed Comi G, Filippi M, Barkhof F, Durelli L, Edan G, Fernandez O, Hartung H, Seeldrayers P, Sorensen PS, Rovaris M, Martinelli V, Hommes OR, Early Treatment of Multiple Sclerosis Study Group: Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet. 2001, 357: 1576-82.CrossRefPubMed
24.
go back to reference Kappos L, Polman CH, Freedman MS, Edan G, Hartung HP, Miller DH, Montalban X, Barkhof F, Bauer L, Jakobs P, Pohl C, Sandbrink R for the BENEFIT Study Group: Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006, 67: 1242-9.CrossRefPubMed Kappos L, Polman CH, Freedman MS, Edan G, Hartung HP, Miller DH, Montalban X, Barkhof F, Bauer L, Jakobs P, Pohl C, Sandbrink R for the BENEFIT Study Group: Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006, 67: 1242-9.CrossRefPubMed
25.
go back to reference Panitch H, Goodin DS, Francis G, Chang P, Coyle PK, O'Connor P, Monaghan E, Li D, Weinshenker B, EVIDENCE Study Group: Evidence of interferon dose-response: Europian North American Compartative Efficacy; University of British Columbia MS/MRI Research Group. Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial. Neurology. 2002, 59: 1496-506.CrossRefPubMed Panitch H, Goodin DS, Francis G, Chang P, Coyle PK, O'Connor P, Monaghan E, Li D, Weinshenker B, EVIDENCE Study Group: Evidence of interferon dose-response: Europian North American Compartative Efficacy; University of British Columbia MS/MRI Research Group. Randomized, comparative study of interferon beta-1a treatment regimens in MS: The EVIDENCE Trial. Neurology. 2002, 59: 1496-506.CrossRefPubMed
26.
go back to reference Ozminkowski RJ, Marder WD, Hawkins K, Wang S, Stallings SC, Finkelstein SN, Sinskey AJ, Wierz D: The use of disease-modifying new drugs for multiple sclerosis treatment in private-sector health plans. Clin Ther. 2004, 26: 1341-54.CrossRefPubMed Ozminkowski RJ, Marder WD, Hawkins K, Wang S, Stallings SC, Finkelstein SN, Sinskey AJ, Wierz D: The use of disease-modifying new drugs for multiple sclerosis treatment in private-sector health plans. Clin Ther. 2004, 26: 1341-54.CrossRefPubMed
Metadata
Title
Analysis of NAMCS data for multiple sclerosis, 1998–2004
Authors
Jagannadha R Avasarala
Cormac A O'Donovan
Steve E Roach
Fabian Camacho
Steven R Feldman
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2007
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-5-6

Other articles of this Issue 1/2007

BMC Medicine 1/2007 Go to the issue