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Specialty pharmacies step up to successfully manage patients with multiple sclerosis

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Multiple Scleroris

Olivia C. Welter, PharmD

A recent study conducted across multiple health-system specialty pharmacy sites found that pharmacist interventions can be beneficial for patients with multiple sclerosis (MS) who are on disease-modifying therapies (DMTs).

Published online in AJHP on August 9, 2023, the study sought to identify rates of patient-reported outcomes, including relapse; impacted productivity—framed as missing work, school, or planned activities—and hospitalization. Additionally, investigators evaluated the associations within patient-reported outcomes, pharmacist outcomes, and patient and medication characteristics.

“The most important piece of this study is that health-system specialty pharmacies were able to collaborate to demonstrate that pharmacists in the health-system specialty pharmacy care model play an important role in educating patients and managing DMTs resulting in positive clinical outcomes for patients with MS,” said lead author Autumn Zuckerman, PharmD, from Vanderbilt Specialty Pharmacy.

Study background and findings

Zuckerman and colleagues conducted this multisite study at Vanderbilt University Medical Center, University of Rochester Specialty Pharmacy, Fairview Specialty Pharmacy, and WVU Medicine Specialty Pharmacy Services, Allied Health Solutions. Because the sites were affiliated with separate health systems, researchers standardized patient-reported outcome assessments and defined pharmacist actions into 6 categories: general medication education, safety, effectiveness, adherence, nonfinancial coordination of care, and financial coordination of care.

Patients were prospectively enrolled in the study if they had at least one fill of a self-administered DMT on record at the health-system specialty pharmacy. Once enrolled, patients were followed for 12 months and were asked to respond to patient-reported outcome assessments. A total of 968 patients were enrolled and nearly 7,000 patient-reported outcome assessments were collected during the study period. Patients reported that productivity was affected most often, with 141 patients experiencing this patient-reported outcome 239 times; 45 patients experienced MS-related relapse; and 18 experienced MS-related hospitalization. Investigators noted that these were low rates compared with prior studies.

A total of 3,683 pharmacist actions were documented with a median of four actions per patient. The most common action category was general medication education totaling 1,570 actions, followed by safety with 1,226 actions, and adherence at 479 actions. Overall, glatiramer acetate accounted for 31.6% of fills, fingolimod for 18.2%, dimethyl fumarate for 17.8%, and teriflunomide for 12.5%.

Across medication classes, rates of general medication education actions were similar, but the actions happened frequently. The study found that glatiramer acetate was associated with a lower rate of safety actions than the other medication classes, and fumarates were associated with higher rates of adherence actions than the other classes. Effectiveness actions were not as frequent, with authors indicating that patients taking drugs such as fingolimod had a rate of this action once every 4.3 person-years on the treatment and those taking teriflunomide had a rate of once every 8.5 person-years. Similarly, nonfinancial coordination of care actions were not very frequent with rates of these equaling once per 4 to 5 person-years, and financial coordination of care rates at once every 5 person-years for fumarates and up to once every 27.7 person-years for teriflunomide.

Overall, more pharmacist actions were performed for patients with impacted productivity, indicating that health-system specialty pharmacies can better guide their staffing initiatives by anticipating that these patients may require more education or safety monitoring interventions from their pharmacist.

Notably, the study authors acknowledged that the landscape of brand versus generic DMTs is evolving, potentially foreshadowing a higher need for financial coordination actions from pharmacy teams. The first generic fumarate was approved and launched during the study period, which could explain why this study found that the rates for financial coordination actions were much higher for fumarates than any other DMT class.

The study is the first to successfully standardize patient-reported outcome assessments across all sites, which Zuckerman noted is a significant achievement. “If we could expand this standardization as an industry, we could better compare practice models and more effectively use data to build best practices in caring for patients on DMT,” Zuckerman said. If future research identifies which interventions are most impactful, health-system specialty pharmacy can focus on standardizing them profession-wide. ■



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