FDA-Approved NMOSD Treatments: What Is the Top Barrier to Access?

Academic neuroimmunologists reported feeling comfortable in prescribing the US Food and Drug Administration (FDA)-approved treatments, including eculizumab, inebilizumab, and satralizumab, for patients with neuromyelitis optica spectrum disorder (NMOSD). However, a majority of them considered insurance coverage or cost as a barrier to prescribing these treatments. These are the results of a survey published in Multiple Sclerosis and Related Disorders.

Due to limited information on the rate of adoption for NMOSD treatments in clinical practice, researchers conducted a survey with academic neuroimmunologists in the US.

Neuroimmunologists affiliated with neurology resident programs at university hospitals were identified for the analysis. Participants were sent a 14-question electronic survey that included questions on their background, prescription patterns for NMOSD, and barriers to use of the novel NMOSD treatments.

Of 381 eligible participants, 33 practicing in 18 US states completed the survey. Of the respondents, 28 (84.8%) completed a fellowship in neuroimmunology and reported providing treatment to a median of 15 patients with NMOSD.

All participants reported feeling comfortable in prescribing the treatments for NMOSD, with preference for 1 treatment over the others (P_adj <.01). In addition, the survey results indicated a higher comfort level especially with inebilizumab and satralizumab with a greater number of cases of NMOSD treated (P_adj <.01 and =.04,respectively).

A total of 12% of the respondents reported not having prescribed the NMOSD treatments in any clinical scenario.

From the survey results:

• 42% of participants reported prescribing the treatments for 1% to 25% of patients with newly diagnosed NMOSD;
• 60% of participants prescribed the treatments for a majority (75%-100%) of patients with NMOSD after relapse; and
• 69% of participants did not prescribe treatments for patients with clinically stable NMOSD.

As a barrier to prescribing the NMOSD treatments:

• 42% of respondents reported insurance coverage and costs;
• 6% of respondents reported pharmacy/formulary availability;
• 15% of respondents reported lack of medication experience; and
• 18% of respondents reported patient declinations.

None of the respondents reported safety concerns as a barrier to prescribing the NMOSD treatments.

Study limitations included the low response rate, lack of incentives for survey completion, and the brief nature of the survey.

“[F]uture studies are needed to better ascertain adoption and utilization of NNTs [novel NMOSD treatments] among a larger, more diverse sample of neurologists, including those in other practice settings than academic institutions,” the researchers concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.