To assess the influence of demographic factors (age, gender, ethnicity and deprivation) on the prescribing of the high-efficacy disease-modifying therapies (HE-DMTs) alemtuzumab and ocrelizumab in patients with relapsing-remitting multiple sclerosis (RRMS) in Manchester, UK.

MS is the commonest non-traumatic cause of significant neurological disability in young adults, and is associated with high economic and disease burden. Studies have measured the impact of socio-economic status on prescribing in MS. However, there is limited research on the influence of other demographic factors on HE-DMT prescribing.

A retrospective analysis of the electronic records of patients treated with alemtuzumab or ocrelizumab was undertaken to gather demographic data including age, gender, ethnicity, and postcodes for Index of Multiple Deprivation. Fisher Exact Tests were applied to assess the impact of ethnicity and deprivation, and Chi-Square Tests assessed the impact of age and gender on prescribing.

437 patients with RRMS who were treated with alemtuzumab or ocrelizumab were identified. 250 (57%) patients were treated with alemtuzumab and 187 (43%) with ocrelizumab. 283 (65%) patients were female. 387 (89%) patients were white. There was no statistically significant difference in HE-DMT prescribing based on gender, ethnicity or relative deprivation (p > 0.05). However, there was a statistically significant difference in HE-DMT prescribing based on age (p < 0.05). The majority under 50 years old were prescribed alemtuzumab (60%), and the majority over 50 years old were prescribed ocrelizumab (59%).

The choice between alemtuzumab and ocrelizumab in our centre is not influenced by gender, ethnicity or relative deprivation. Ocrelizumab is more likely to be prescribed in older patients. This could reflect evidence of benefit in primary progressive MS, with ocrelizumab being extrapolated to older patients who may be in the transitional or secondary progressive phase. Alternatively, it could reflect relative concerns or contraindications to alemtuzumab with co-morbidities in older patients.