Expanding the Pharmacist’s Role in Multiple Sclerosis Care, Clinical Trials, and Collaborative Practice

In this Q&A with Pharmacy Times, Jacquelyn Bainbridge, PharmD, FCCP, FAES, MSCS, discusses how the role of pharmacists has evolved alongside major advances in multiple sclerosis treatment. She explains how pharmacists are instrumental in clinical trials, from leading and supporting study operations to interpreting data across all trial phases and helping identify the right patients for emerging therapies. Bainbridge also highlights the growing importance of dedicated clinic-based pharmacists in patient education, medication selection, monitoring laboratory values, and supporting shared decision-making. Additionally, she emphasizes how collaborative practice agreements provide pharmacists with greater autonomy and clarity within the care team, ultimately helping close gaps in patient management and improve outcomes in multiple sclerosis care.

Pharmacy Times: From your perspective in neurology pharmacy, how has the multiple sclerosis treatment landscape changed over the past decade?

Jacquelyn Bainbridge, PharmD, FCCP, FAES, MSCS: It’s changed a lot because we have such a huge armamentarium of medications to treat multiple sclerosis. The disease state, specifically the [disease-modifying therapies] DMTs. Now we have more options for patients, [and] not only do we have more options for patients, but we’re now pulling in different types of multiple sclerosis—not just relapsing-remitting, the most common form, but also the progressive forms.

So much has changed, even when we talk about the descriptors or phenotypes of multiple sclerosis. We know that people can have a relapsing-remitting course, or a secondary or primary progressive course, and it can be active or non-active. I think we just have many more options now, and we have different formulations.

We’ve moved on from all the self-injected DMTs, which were the first-generation DMTs. Now we have oral options for patients, and we have infusions. We have infusions that are given less frequently, so we really have a lot of different therapies and the ability for patients to have a say in what their treatment looks like.

The shared decision-making process is very active, and everyone is very well acquainted with it in the multiple sclerosis space. It’s really an exciting time. Multiple sclerosis went from a time when you knew you were going to need an assistive device or a wheelchair at some point in your life because we didn’t have good therapies or any therapies, to a completely different future and forecast for those individuals.

Pharmacy Times: What role do pharmacists play in translating emerging MS research into day-to-day patient care?

Bainbridge: Pharmacists can be very instrumental in running clinical trials. They can actually take the lead on many of those clinical trials, or they can be part of the clinical trial. I always train and encourage that with our students, and I have done that in our clinics. I also have my own clinical trial right now in a different disease state, but pharmacists can really take on that role.

Pharmacists are also very critical when it comes to interpreting the results of clinical trials that they may not have taken part in, whether those are phase 1, 2, or 3 clinical trials, or even phase 4 post-marketing surveillance. Pharmacists are instrumental in interpreting those results and helping to find the right patient for that medication based on the clinical data.

This includes evaluating the side effect profile, understanding what patients were enrolled, what type of multiple sclerosis they had, and what other medications they were taking. That is very important, especially when discussing a new therapy, because you need to know whether it will have drug interactions or produce certain adverse events in patients.

Pharmacy Times: What gaps in MS care do you see where pharmacists can have the greatest impact moving forward?

Bainbridge: Making sure there’s a dedicated pharmacist in the clinic is something that has changed a lot, and now that’s really common. However, there are still some clinics that don’t have a pharmacist. I think it’s important for the pharmacist to be present not only for education and patient counseling but also for patient selection for medications and having more time to discuss therapies and any questions a patient may have about their care or treatment as part of the team.

I think we fulfill many gaps when we’re part of that team by making sure the patient is managed well and properly monitored. Many times, laboratory values are ordered, but no one really looks at them. Making sure someone is actually taking the lead is important, and the pharmacist is very well equipped to take the lead on ordering the labs that need to be done for the patient, ensuring they are reviewed, and communicating those values to the team so treatment decisions can be made based on those lab values.

Pharmacy Times: What roles do collaborative practice agreements (CPAs) play in optimizing pharmacist involvement in multiple sclerosis care?

Bainbridge: Collaborative practice agreements give the pharmacist more autonomy when it comes to therapies that are prescribed and monitored. Collaborative practice agreements clarify the role of the pharmacist with the patient, with their medications, and on the care team. I think they are a good thing [to have].