Research suggests women are less likely to be prescribed DMTs than men

There are now over a dozen different disease modifying therapies (DMTs) for people with relapsing remitting MS. Women are almost three times more likely to get MS than men. But some previous research has shown that women are less likely to be prescribed a DMT.

When DMTs were first made available to patients, we knew very little about how safe they are during conception, pregnancy and breastfeeding. That’s why people were initially recommended to stop taking DMTs during those periods. We now know more about the safety of many DMTs during these times. For example, we now know that some DMTs are safe to be taken during pregnancy, whereas others should be stopped when you’re pregnant. 

But researchers in France found that despite our growing knowledge of the safety of DMTs, women are still less likely to be prescribed DMTs – in particular highly effective ones. 

What did the researchers do?

The researchers used data from the French MS Registry.

They looked at data from over 22,000 people with relapsing remitting MS aged between 18 and 40. They then calculated the annual probability that someone was prescribed a DMT and what type of DMT they were prescribed. And if this was connected to things like sex, level of disability or pregnancy.

What did they find?

The researchers found that women were 8% less likely to receive a DMT than men. And they were 20% less likely to receive a highly effective DMT, even when they took into consideration that some people stopped taking their DMT during or after pregnancy and the severity of someone’s MS. 

They also found that the number of women taking a DMT started to decline 18 months before they became pregnant. The researchers think this is because clinicians weren’t prescribing DMTs when anticipating that the patient might become pregnant.  

But the researchers didn’t look at the reasons for these treatment choices. So we don’t know if the decisions were made by the clinicians or the person with MS themselves.

What does this mean?

This research highlights that many women may currently miss out on getting the right treatment. This is called therapeutic inertia – when a clinician doesn’t change someone’s treatment plan even though the current approach isn’t working well enough.

There could be many reasons for this therapeutic inertia. For example, clinicians might not be informed on the latest recommendations for the use of DMTs during pregnancy. Or there might be bias in their treatment decisions. Women with MS may also feel hesitant to start or continue taking a treatment when thinking about planning a pregnancy. 

Not prescribing or delaying the prescription of DMTs can lead to higher relapse rates, more disability and poorer quality of life. It means that women miss out on the benefits of being on treatment for their MS. 

Even though this research was done in France, it is likely similar things happen in the UK and other countries. For example, researchers using the UK MS Register found that women were less likely to be prescribed a DMT. But they didn’t look at pregnancy.

The need for more research

Research is essential to improve our understanding how DMTs are prescribed and if they’re safe during pregnancy. But only by providing adequate training and information that can empower both clinicians and patients to make informed decisions about their care and ensure they have access to the best DMT for them. 

That’s why we’re funding a project to understand more about which DMTs cross the placenta during pregnancy. And the MS Pregnancy Register is collecting data about MS and pregnancy.

If you have any questions about which DMTs might be suitable for you, we recommend speaking to your healthcare provider. You can also call our MS Helpline for advice.

Find out more about pregnancy, birth, breastfeeding and MS