Multiple sclerosis (MS) is a complex neurological condition that predominantly affects young adults, with varying degrees of severity and course among individuals. Recent research has illuminated a concerning trend in the treatment of relapsing forms of MS: women, who account for a significant proportion of MS patients, are less likely than men to receive appropriate disease-modifying therapies (DMTs). This discrepancy is evidenced by findings presented by Antoine Gavoille, MD, and colleagues at the recent European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) annual meeting in Copenhagen. An analysis of a French registry dataset involving 22,657 patients highlighted gender-related inequities in accessing DMTs, signalng a need for urgent intervention.
The study monitored patients with an average age of onset at 30 and a median follow-up period of 11.6 years. Among these, 74.2% were women. The findings revealed that women had an overall reduced likelihood of being treated with any DMT (OR 0.92) as well as a marked deficiency in receiving high-efficacy DMTs (OR 0.80). This pattern suggests a troubling phenomenon termed “therapeutic inertia,” where the delay or reluctance to initiate treatment in women contrasts starkly with their male counterparts. Co-author Sandra Vukusic, MD, PhD, emphasized that such inertia could contribute to a worsening of disease activity and the progression toward long-term disability during periods when patients are not adequately treated.
One pivotal factor influencing treatment decisions for women is the potential for pregnancy, which seems to overshadow the overall clinical management of MS. Neurologists may hesitate to prescribe DMTs to women in their childbearing years due to concerns regarding pregnancy-related complications. As Gavoille indicated, treatment disparities can occur even before a planned pregnancy materializes, leaving many women under-treated or missing out on effective therapies just for the mere possibility of becoming pregnant. Women are likely to harbor personal apprehensions regarding the risks that medication could pose to fetal health, which further compounds these treatment gaps. Neurologists’ uncertainty in navigating the nexus of MS treatment and pregnancy further exacerbates the issue, resulting in diminished confidence among female patients seeking effective care.
The registry data provided valuable insights into treatment trends, identifying that specific DMTs were more frequently underutilized by women across various time frames. For instance, while Interferon beta and natalizumab saw initial lower usage in women, their rates matched those of men as time progressed. However, other therapies like teriflunomide and S1PR-modulators remained consistently underused. Moreover, a notable observation was that after five years of disease progression, treatment disparities became more pronounced, particularly regarding high-efficacy DMTs.
A subanalysis of 5,268 patients highlighted that under-treatment significantly intensified outside of pregnancy and post-partum periods, starting approximately nine months before conception for women. This foregone opportunity for effective treatment appears to contribute substantially to the observed gender disparity in access to DMTs.
These findings pose critical questions regarding the current treatment paradigms in the management of relapsing MS among women. There is an urgent necessity to reassess treatment decision-making protocols, particularly regarding younger women. As Vukusic highlighted, many women might not be receiving the most effective therapies at crucial times, predominantly due to unfounded fears related to pregnancy. In an era nearing the availability of highly effective DMTs, it is paramount to ensure timely access to these treatments without the overhang of potential risks that might never materialize.
As the conversation surrounding MS and gender disparities in healthcare continues to evolve, the medical community must address these inequities head-on. Improving awareness, training, and guidelines for healthcare providers can pave the way for more equitable treatment protocols and better clinical outcomes for women with MS. The road to balanced and effective healthcare for all MS patients is challenging but essential, and it requires both systemic change and personal advocacy from individuals affected by the disease.
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