New findings suggest high-efficacy disease-modifying therapies administered at home may provide a more suitable option for Medicare beneficiaries with multiple sclerosis. The burden of travel was found to be linked to the risk of lower adherence, particularly in rural areas.

Ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and ublituximab – generally considered high-efficacy DMTs for MS – are all administered by intravenous infusion, except ofatumumab, which is an at-home self-injectable DMT. Travel to an infusion center could have an effect on patients with MS. Norvatis researchers set out to assess adherence and persistence to infusion DMTs and evaluate the burden travel poses.

Medicare Fee-For-Service data were used to identify adult patients with MS who received an infusion DMT of interest from January 2017 to September 2024, with 12 or more months of preindex continuous enrollment. The commuting distance was based on the five-digit zip codes involving patient residence and the infusion facility. Persistence was defined as the number of days from index until treatment discontinuation or DMT switch (maximum allowed gap of 90 days). Adherence was based on the proportion of days covered. 

Among 20,961 included patients, the average age was 57 years, 69 percent were female, 80 percent were white, 80 percent resided in urban areas, and 84 percent received ocrelizumab. Adherence at 24 and 36 months was 43 percent and 35 percent, respectively. Persistence to index infusion DMT at 24 and 36 months was 43 percent and 29 percent, respectively. There was an about 10 percent decrease in adherence for rural patients with two-way travel distance between 61 and 120 miles compared with those with less than 60 miles from the infusion center. In addition, 75 percent of DMT recipients were not receiving their infusion(s) at their nearest infusion facility, traveling an average additional two-way distance of 52 miles.

Among Medicare beneficiaries with MS, adherence and persistence to infusion DMTs were low, with less than 50 percent of patients nonpersistent after two years and less than two-thirds of patients nonpersistent after three years. Travel burden was linked to lower adherence, particularly in rural areas. High-efficacy DMTs administered at home may provide a more suitable option for Medicare beneficiaries with MS who are at risk for nonadherence due to the burden of travel.

The findings were presented at CMSC 2025 in Phoenix.