Evaluating the Prescribing Patterns of Anti-Spasticity Medications in Patients with Multiple Sclerosis

Background and/or Objectives: Identify the prescribing the patterns of anti-spasticity medications in individuals with multiple sclerosis.

Design: A retrospective review of adult patients with multiple sclerosis ICD-10 codes utilizing a primarily national database, TriNetX. Primary medications evaluated were Baclofen, Tizanidine, Dantrolene, and/or Diazepam. Secondary treatments analyzed were Gabapentin, Botulinum Toxin Type A, Clonidine, and Ketamine.

Setting : TriNetX was used to query patients. The final cohort included 66 health care organizations with less than one percent of the cohort from organizations outside of the United States.

Participants : Adult patients at least 18 years old with MS diagnostic codes (ICD 10 Code: G35) between the years of 2015 and 2024 and had a diagnosis of cramp and spasms/muscle spasms (ICD 10 Codes: R25.2 and M62.83).

Interventions: Active prescriptions for Baclofen, Tizanidine, Dantrolene, Diazepam, Gabapentin, Botulinum Toxin Type A, Clonidine, and/or Ketamine. Line of Treatment (LOT) was defined as when a new medication was started and included if any additional anti-spasticity medications were started within 14 days of the new LOT.

Main Outcome Measures: Percentage of patients in the cohort using the aforementioned medications were populated and stratified between first and sixth line of treatment. Mean length of time patients were on the anti-spasticity treatments were averaged with standard deviation calculated using the database.

Results: The database queried 8,414 individuals that utilized at least one of the primary medications. Baclofen was the most common first line medication prescribed in 56% of the cohort, followed by Tizanidine prescribed in 14%. Approximately 29% and 32% of the individuals that used baclofen and tizanidine as first line, respectively, did not require a second line. Gabapentin was the most frequently used second line. Dantrolene was used by only forty patients.

Conclusions: Our study demonstrated that Baclofen is the most common anti-spasticity medication used in patients with multiple sclerosis with Gabapentin as a common secondary medication.