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Multiple sclerosis: Main cause of severe physical disability in young women can be better treated

MPs and other policy makers should not let Brexit challenges draw attention and funding away from the chance to improve outcomes for everyone living with MS says Professor David Taylor from UCL School of Pharmacy

Multiple sclerosis is currently the most common non-accidental cause of severe physical disability in British adults aged under 50 years. It directly affects over 100,000 people in the UK, approaching three in every four of whom are women. A new UCL School of Pharmacy report, published today, notes that NHS MS care provision was recently described as a lottery, with poorer people living in less advantaged areas being least likely to receive high-quality care. There are continuing concerns about the variable use of medicines that can reduce the frequency of brain damaging relapses, and also about the quality of rehabilitative and allied support. The new report raises questions on gender bias and access to optimally effective treatments.

Problems such as diagnostic delays can be linked to the fact that the number of neurologists in Britain is much lower than in countries such as Germany. There are only 100 neurologists specialising in MS in the UK. Other problems relate to social care and community health service funding cuts.

However, there are now important opportunities for providing better treatment to everyone with MS. Developments in immunology (in part linked to cancer care innovations) have opened the way to fundamental advances in MS treatment, including potentially curative autologous (patients’ own cell based) stem cell transplantation techniques. A new NHS England treatment algorithm (rule set), published last month, could ensure that all MS patients in England have funded access to effective early treatment.

Report author Professor David Taylor commented today: “The new NHS England treatment rules should prove to be an important step towards making the NHS a world class MS care provider. At best the algorithm will enable all new NHS patients to get optimal early treatment. Yet to be fully effective it must be used in ways that are sensitive to variations in individual needs and treatment responses and flexible enough to allow the use of further treatment improvements in a timely way. One key danger to avoid is that, even if newly diagnosed patients receive better care, the clinical and social needs of more disabled people with later stage disease will not be met as well as possible because of short-term attempts to save money. There is a strong long term economics based case for seeking to provide the best possible care to everyone with MS, whatever their disease stage.”

Other key recommendations from the new UCL School of Pharmacy report (the publication of which coincides with Parliament resitting) range from extending the clinical roles of specialist pharmacists and nurses through to raising public and political awareness of MS and the value of early and effective treatment. It finds that:

  • In the foreseeable future the number of NHS neurologists with a special interest in MS is unlikely to increase, partly because of the effects of Brexit on the willingness of highly skilled doctors to work in Britain. In such circumstances enabling specialist nurses and pharmacists to play fuller parts in diagnosing and treating MS will be the most viable way of improving patient care and support for GPs seeking to diagnose MS and provide good quality treatment and support;
  • Modern disease modifying medicines (DMTs) may reduce MS death rates and can cut relapse (acute attack) rates by around 50 per cent. However, because they are new there are still uncertainties as the extent to which they will ultimately stop people with MS becoming wheelchair users and/or progressing to more severe levels of disability. Fears about side-effects also affect prescribers and medicine takers. Yet there is evidence that many women and men with MS are prepared to accept the risks involved in return for the benefits available; and
  • By the 2030s it might be that, if sufficient public and private money is invested, a vaccine to protect against Epstein-Barr virus infection (best known as the cause of glandular fever) will be able to prevent MS cases. Programmes aimed at finding children, teenagers and young adults at raised genetic risk of MS and avoiding threats such as vitamin D deficiencies, early life obesity, smoking and exposures to organic solvents could also cut the numbers of cases. But presently reducing the MS burden will depend primarily on improving the early use of disease modifying medicines and extending access to stem cell transplantation for individuals with rapidly developing disabilities.

The UCL School of Pharmacy analysis argues that MPs and members of the House of Lords should press for the publication of more comparative statistics on all aspects of MS care quality. Performance measures should show clearly how place of residence, sex, social class and ethnicity influence MS occurrence, treatment and outcomes.

Professor Taylor concluded: “Better international comparisons relating to the quality of life of people living with MS are also needed. Politicians sometimes claim that the NHS is the world’s best health care system. But in reality its performance in areas like multiple sclerosis treatment has been mixed. National leaders should see MS care as a priority for health service performance improvement, not least because of the opportunities available for enhancing women’s health in all sections of the British community.”

Source: MS-UK 09/10/18

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