Neurologist working to improve access to MS treatments

Together with multiple sclerosis (MS) experts, biostatisticians and clinicians from across the globe, a UK HealthCare neurologist has helped compile an essential list of MS medications for patients in resource-poor settings.

Jagannadha "Jay" Avasarala, M.D., Ph.D., director of the Comprehensive Care Center for MS and Neuroimmunology at the Kentucky Neuroscience Institute, currently serves as a panel member of the Multiple Sclerosis International Foundation (MSIF) and previously served as chair of the American Academy of Neurology (2020-22). The list has been submitted to the World Health Organization (WHO) for approval.

The 18-month effort was recently published in the The Lancet Neurology. Avasarala states that "access to treatments for neurological disorders is egregiously insufficient, particularly in low-income and middle-income countries."

"The inclusion of therapeutic agents on the WHO Model List of Essential Medicines (EML) is an initial step to potentially increase their availability worldwide, as the list serves as a guide for the development of national and institutional EMLs," said Avasarala. A decision by the WHO on the list submitted is expected in the coming weeks.

News of the publication and anticipation of a decision comes during the month of March, which is recognized as Multiple Sclerosis Awareness Month. MS happens when one's immune system attacks the nerve cells and renders them unable to properly transmit information, causing balance issues, weakened vision, fatigue, and other unpredictable symptoms. Approximately 2.5 million people worldwide suffer from multiple sclerosis. The cause is unknown, and there is no definitive cure.

The MSIF, a global network of MS organizations, along with people affected by MS, volunteers and staff from around the world, had applied in 2018 for three disease-modifying treatment (DMTs) to be added to the WHO EML. That attempt was unsuccessful as the WHO said that no clear evidence was provided that the DMTs listed were superior to other drugs in safety, efficacy and affordability and that the application had excluded commonly used drugs and off-label medications.

Based on that feedback, as Avasarala explained, the group put together by MSIF went back to the drawing board and in collaboration with the Cochrane MS group and using the McMaster GRADE system, systematically assessed all on-label and off-label DMTs for MS. The group worked for more than a year through multiple Zoom meetings during the pandemic. Through their efforts, the group officially submitted a revised application to the WHO that consists of a comprehensive list of DMTs for MS to include in their EML.

The WHO Expert Committee will meet April 24–28, 2023, to discuss all EML applications. If successful, Avasarala says the MSIF application—which is comprehensive, rigorous and has the endorsement of international organizations—could serve as a blueprint for EML applications for other neurological disorders.