PND67 Factors Associated with Prescribing of Disease-Modifying Agents Among Older Adults with Multiple Sclerosis: A Real-World Analysis of Electronic Medical Records

Abstract

The value of disease-modifying agents (DMA) for managing Multiple Sclerosis (MS) in older adults is highly debated as most older adults have progressive MS. Hence, this study examined the DMA prescribing and the factors associated with prescribing of DMAs in older adults with MS using electronic medical records (EMR) data. Retrospective longitudinal study was conducted using the TriNetX, a federated EMR network from the US, data from 2016–2019. The study included older adults (≥60 years) with MS diagnosis (ICD-9/10-CM codes: 340/G35) having any prescription record during the study period. Patients with DMA prescriptions were identified and further classified into injectable, oral, or infusion users based on their prescription on the last DMA prescription. Multivariable logistic regression model was used to evaluate factors associated with prescribing of DMAs using the Andersen Behavioral Model. The study cohort consisted of 12,922 older adults with MS with 2,455(18.99%) receiving DMA prescription. The frequently prescribed DMAs were injectable (10.46%), followed by oral (6.06%) and infusion (2.40%). Multivariable logistic regression revealed older adults between 60–64years [Adjusted Odds Ratio (aOR)=2.39] and 65-69 years (aOR=1.60) had higher odds of receiving DMA compared to older adults 70 years and above. African Americans (aOR=1.71) had higher odds of receiving DMA prescriptions compared to Caucasians. Presence of symptoms (general, speech, walking difficulty) and use of symptomatic drugs (anti-fatigue, bladder dysfunction medications, antispasmodics, antidepressants and relapse medications) had higher odds of being prescribed DMA. Further, certain comorbidities (hypertension, neurological disorders, congestive heart failure) and healthcare utilization (emergency room, inpatient, outpatient visit) were associated with lower odds of receiving a DMA prescription. Nearly one in five older adults with MS are prescribed DMAs. Predisposing and need factors are associated with DMA prescribing in older adults. Further studies are needed to understand the clinical outcomes associated with DMA use in older adults with MS.