Stepped drug plans are coming between multiple sclerosis patients and promising new treatments, according to an expert in the field.

Dr. Caroline Geenen, a consultant neurologist and chief of medicine at Markham Stouffville Hospital, told attendees at the Benefits Canada’s Chronic Disease at Work conference last month that several newly approved drugs have shown themselves to be particularly effective in trials as first-line treatments for MS sufferers soon after their diagnosis with the chronic autoimmune disease that affects the central nervous system.

However, she says drug plans in both the private and public sector often require patients to try older, cheaper treatments first, only allowing them to move on to the newly developed and costlier medications if the first option doesn’t work.

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“We experience a great deal of frustration in having patients with very active MS, that we would like on the strongest therapy they are willing to take,” said Geenen. “You want to treat patients before the horse is out of the barn, but we have to suffer through an ineffective drug to get to the one we want to use.”

The number of drugs available to MS sufferers over the last 20 years has grown significantly, especially for those with the relapsing, remitting version of the disorder, according to Geenen, who said that symptomatic treatments can also make a large improvement to a patient’s quality of life and ability to work, even if they have no impact on the long-term development of the disease.

“There are no free lunches,” she cautioned. “The most effective treatments have the highest chance of side-effects.”

Geenen said Canada has one of the highest incidences in the world of MS. The disease is twice as prevalent in Ontario compared with Canada as a whole, with one in 500 people in the province suffering from it. Women are also three times more likely than men to have the disease.

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“Diagnosis is usually made between the ages of 20 and 40, so it’s obviously impacting people in the prime of their lives, when they’re in the process of having families and starting careers,” said Geenen. “There’s a huge range for what patients undergo with this condition. Sometimes, MS has a very random course. I often say every patient is like a snowflake — there is absolutely no patient who behaves just like another patient with this condition.”

Despite limited knowledge about the cause of MS, there are suspicions it has something to do with where people live, Geenen noted. For instance, she said a person who moves to Canada before adulthood from the Caribbean, where there are virtually no cases of MS, will acquire the Canadian incidence of the disease.

Copyright © 2020 Transcontinental Media G.P. Originally published on

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