Access to infusion centers is critical for the administration of many highly effective DMTs in MS.

In this retrospective cohort study, adult MS patients who completed a visit at a single MS center from 1/1/2015-6/30/25 were included. Infusion center locations (n=4,041) were used to compute spatial accessibility to infusions for all US census tracts. A multivariable logistic regression model was used to evaluate the association between geographic access to infusion centers and the use of infusion DMTs (CD20 monoclonal antibodies, natalizumab, alemtuzumab, cyclophosphamide) adjusting for age, sex, race, ethnicity, education, MS disease duration, MS course, patient determined disease steps (PDDS), area deprivation index (ADI), and rural-urban commuting code (RUCA). 

7,805 patients (mean [SD] age of 54.5 years [13.1], 73% female, 82% white, 96% non-Hispanic, 86% metropolitan, 55% relapsing remitting MS, 30% no disability, disease duration 17.1 years [10.5], 49% high efficacy DMT) were included. Greater access to infusion centers was not associated with receiving an infusion DMT (OR 1.00, p>0.05). Higher access to infusion centers was seen for Black compared to White (14.4%) and Hispanic compared to non-Hispanic (11.1%) patients (p<0.01). Lower access was seen for patients residing in the more disadvantaged neighborhoods (-6.5% ADI 20-40, -17.4% ADI 40-60, -21.0% ADI 60-80, -10.0% ADI 80-100), micropolitan (-35.4%), and rural areas (-43.7%) (p<0.01 for all).

Disparities to geographic access to infusion centers exist but distance did not impact the use of high efficacy infusion DMTs for patients. These results suggest that geographic barriers to resources can be mitigated to deliver highly effective treatments.