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McDonald 2017 finally receives PTAC recognition

May 25, 2021 | Advocacy, Media

Still unfunded, but finally acknowledged, McDonald 2017 criteria for diagnosing Multiple Sclerosis (MS) is one step closer to being used in NZ for accessing treatment.

The February 2021 minutes of PHARMAC’s Pharmacology and Therapeutics Advisory Committee (PTAC) were released this month, recommending a medium priority to funding the access criteria to include McDonald 2017 MS.

“The Committee made this recommendation based on the high health needs of people with Multiple Sclerosis who ultimately progress, the health benefits of earlier access to disease modifying treatments and good quality research. The Committee also took into account the potential risk of toxicity from lifelong treatment of patients who may never go on to develop clinically definitive MS and the lack of apparent short-term benefits for patients.” Extract from the Minutes of the February 2021 meeting.

A medium priority recommendation does not alter the current Special Authority Access Criteria for funded Disease Modifying Therapies (DMT’s). PTAC have requested additional information from Pharmac to revisit the recommendation.

MSNZ is committed to seeing this change, writing to Pharmac to act with urgency.

Multiple Sclerosis NZ (MSNZ) have been advocating for Pharmac to update the Special Authority criteria since 2017. This would align NZ practice with international recommendations.  Pharmac continue to use the old definition of clinically definite MS, which requires two clinical attacks. They have declined all requests by MSNZ, despite diagnostic methods and the understanding of MS having progressed.

Acceptance of the 2017 criteria would enable Neurologists to diagnose and treat MS earlier. It is internationally accepted that treating MS early provides the best long-term outcomes for patients. Yet in NZ, patients are unable to start treatment until a second episode or relapse is recorded.

The Trans-Tasman study COMPANZ, compared access to treatments of New Zealanders and those in Tasmania. The study reported worse long-term health outcomes, and response to treatment, for New Zealanders. The primary reason for this was much later access than their Australian counterparts.

The proposed changes would see patients start treatment following 1 recorded episode of symptoms in the last 12 months, or 2 episodes in 24 months, which when combined with other clinical diagnostic criteria, are characteristic of MS as defined by the McDonald 2017 criteria.

“To no longer require patients to suffer a relapse, increasing the risk of both disease and disability progression, would be a huge step” commented MSNZ National Manager Amanda Rose. “We are pleased this has finally been recognised. Pharmac are 4 years behind in making these changes and we urge them to make these changes immediately”.

Dr John Mottershead, Specialist MS Neurologist at Southern DHB, who has been a key figure in addressing this issue with Pharmac said “People with MS and neurologists will be excited that there is now a very real prospect that, in future, early treatment will be funded in NZ, with no need to wait for a second clinical attack.”