Redefining Treatment Success and Monitoring in nrSPMS

In Redefining Treatment Success and Monitoring in nrSPMS, Ryan Fuller, PharmD, Aimee Banks, PharmD, BCPS, MSCS, and Millad Sobhanian, PharmD, BCPS, delve into the balance between objective clinical measures and patient-reported outcomes in assessing MS progression, how health plans can redefine treatment success to include long-term functional outcomes in nrSPMS, and the evolving role of prior authorization and coding, particularly with emerging therapies like BTK inhibitors.

Assessing disease progression and treatment success in non-relapsing secondary progressive multiple sclerosis (nrSPMS) requires a nuanced approach that balances objective clinical measures with patient-reported experiences. Objective tools, such as the Expanded Disability Status Scale (EDSS) and other clinical endpoints, provide standardized ways to track neurological function and monitor disease evolution over time. However, subjective information, including patient-reported symptoms, quality of life, and functional abilities, offers critical context that can help clinicians better understand the real-world impact of the disease and guide individualized care decisions.

From a health plan perspective, redefining “treatment success” in nrSPMS involves moving beyond relapse reduction alone to consider long-term functional outcomes, disability progression, and preservation of independence. This broader view emphasizes the importance of therapies that maintain quality of life and slow irreversible disability, aligning clinical goals with patient priorities.

The prior authorization process and coding play key roles in ensuring appropriate access to MS therapies while maintaining safety and cost-effectiveness. As emerging treatments, such as Bruton’s tyrosine kinase inhibitors (BTKis), become available, prior authorization criteria may evolve to reflect their unique mechanisms, monitoring requirements, and risk profiles. Integrating these clinical and administrative considerations is essential for optimizing outcomes in nrSPMS while supporting evidence-based, patient-centered care.

Led by the moderator, the neurology pharmacists examine the following critical questions:

Do you find more clinical value in objective measures, like EDSS and other clinical endpoints, or do you feel like subjective information helps you better grasp disease progression in patients?

From a health plan perspective, how should we rethink “treatment success” in nrSPMS to account for disability and long-term functional outcomes?

What is the current role of the prior authorization process for MS and future nrSPMS therapies and how is coding utilized?

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, Payer Considerations for Formulary Placement and Final Panelist Thoughts in MS and nrSPMS, further explores multiple sclerosis, highlighting the criteria payers use to determine formulary placement for current and emerging MS therapies, as well as final thoughts from the panelists.