DMT Uptake in MS Potentially Linked to Education Level, Study Suggests

Having a university education was linked to better access and higher uptake of disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) compared with those without university educations, according to a study recently published in Multiple Sclerosis Journal.

In privately funded health care systems in the United Kingdom (UK), DMTs can be very costly and therefore unaffordable to many patients with MS. As higher incomes are associated with higher education, it makes sense that individuals with higher education would have more access to these therapies in a privately funded system.

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In theory, a publicly funded health care system should help mitigate some of these discrepancies. Yet, as the authors of the study noted, these systems do not always lead to equitable access. To investigate these inequities, researchers conducted a study to examine the role of education level in DMT uptake. Data were gathered from the UK MS Register (UKMSR) to first examine the influence of university education on a patient’s uptake and time from diagnosis to starting a DMT. Subsequently, the authors assessed the influence of university education on the uptake of moderate– and high-efficacy DMTs.

Moderate-efficacy DMTs included daclizumab, azathioprine, methotrexate, fingolimod, teriflunomide, dimethyl fumarate, glatiramer acetate, and beta-interferon. High-efficacy DMTs included cladribine, rituximab, ocrelizumab, alemtuzumab, and natalizumab.

This study included 6317 participants with MS diagnosed after the age of 30 between 2008 and 2021. Of this group, 46% received a university education, whereas the remaining 54% attended or completed primary or secondary schooling and were referred to as the school education or diploma group by the authors. It was noted that in 96% of participants, education levels did not impact the period between onset of symptoms and diagnoses, but those with a university education were typically younger at the time of their diagnosis.

Of the individuals with a university education, 62% (n = 1826) underwent treatment with DMTs, compared with 53% (n = 1788) of those with a school education or diploma (P < .001). The chances of an individual receiving a DMT were not dependent on sex. However, a university education, younger age of diagnosis, and a lower normalized MS Impact Scale physical scores—a patient-reported assessment of motor– and health-related quality of life—were significantly associated with DMT treatment (P < .001).

In total, 40% (n = 1167) and 22% (n = 659) of those in the university education group, as well as 37% (n = 1247) and 16% (n = 541) of those in the school education or diploma group, were administered moderate– and high-efficacy DMTs, respectively. Compared with those without a university education, individuals with a university education were more often treated with DMTs of both efficacies (P < .001).

A university education was also significantly associated with a shorter time to initiation of DMTs compared with the periods experienced by those without a university education, with a median initiation of 42 months for university education vs 83 months without (P < .001).

Among the limitations of this study, the authors mentioned potential bias arising from the fact that individuals in higher socioeconomic classes more often take voluntary health assessments. Therefore, individuals with MS who have university educations are more likely to engage with the UKMSR. Additionally, individuals with MS who undergo DMT typically experience more regular follow-ups with MS specialists, who in turn are more likely to recommend they participate in the UKMSR.

With these limitations in mind, the authors recognize their findings suggest that university educations in patients with MS correlate with higher uptake of DMTs compared with patients who are without this level of education. However, they concluded by noting that direct costs of these therapies is an unlikely barrier in a publicly funded health care system.

"In a publicly funded health care system, the impact of education on the uptake of DMTs is unlikely to be caused by many direct costs, as people are not required to pay for appointments, investigations, drugs and other care," the authors said. "Further studies are therefore required to understand the mechanism that drives this inequity, to improve health care access."

Reference

Das J, Rog DJ, Middleton R, Rodgers JW, Nicholas R. University education facilitates uptake of disease-modifying therapies for multiple sclerosis: A community-based study using the UK MS Register. Mult Scler. 2024 Jan 17:13524585231221411. doi: 10.1177/13524585231221411