New recommendations support advocacy for improved access to MS treatments
Essential medicines for low-resource settings: further evidence published.
Last updated: 22nd January 2025
As the global MS community, we know that there is an urgent need to make MS treatments accessible for all people with MS, help people live their best lives and reduce healthcare disparities.
In 2023, we celebrated the addition of MS treatments to the WHO’s Essential Medicines List (EML). Thanks to our efforts together with many partners around the world, rituximab, cladribine and glatiramer acetate are now listed on the EML for treating MS. This underlines the importance of treating MS – wherever people live in the world.
A new publication in the Multiple Sclerosis Journal provides added emphasis to the WHO EML listing by making available the rigorous evidence and decision-making that was part of the application process. This scientific peer-reviewed publication will be an important advocacy tool for everyone wanting to improve access to MS disease-modifying therapies (DMTs).
The recommendations in this publication were made by the MSIF Essential Medicines Panel, comprising people with MS from Uruguay, Serbia, Namibia and Morocco, representatives from MSIF member organisations, as well as healthcare professionals, MS researchers and policy experts. The process was supported by the Cochrane MS group, who led the research work and McMaster GRADE Centre, who took the methodological lead. Both groups are internationally regarded as experts in the field of evidence reviews and decision-making. The Panel not only considered evidence for how safe and effective the different DMTs were, it also considered a broad set of criteria such as the feasibility of using different DMTs in low resource settings.
What are the recommendations?
The treatment of MS does not follow a “one size fits all” approach. People with MS have different requirements depending on their individual circumstances (e.g. age, family planning status, other health conditions) as well as how they respond to different treatments or experience side-effects. Therefore, there is no single recommended treatment for MS.
These recommendations describe which DMTs for MS should be available, at a minimum, in low-resource settings. When we talk about low-resource settings, this is not only low- and middle-income countries, but also may include specific populations in higher-income countries, for example refugees and people without medical insurance coverage.
Very importantly, if a DMT is not listed in these recommendations, it does not mean that it is ineffective or should not be available. We emphasise that this evidence should not be used to restrict access to DMTs.
For relapsing forms of MS, the panel recommended use of:
- cladribine
- dimethyl fumarate
- fingolimod
- ocrelizumab
- interferon beta 1a
- interferon beta 1b
- glatiramer acetate
For active, progressive forms of MS, the panel recommended use of:
- rituximab
- glatiramer acetate
- ocrelizumab
- interferon beta 1a
- fingolimod
- interferon beta 1b
How can you use these recommendations?
Three key actions needed at the national level to improve access to essential medicines, which were outlined in another journal article, are:
1. Prioritisation: Advocate for policy changes in the national health systems to recognise and prioritise MS by mobilising attention and resources.
- The recommendations can be used to prioritise MS in health systems by drawing attention to the fact that nearly 40 global experts agree that MS should be treated in all settings.
2. Standard of MS care: Ensure current and appropriate national consensus statements, treatment guidelines/algorithms and formularies are in place, and where possible, officially recognised.
- The recommendations could contribute to the development of standards of MS care, being adapted as needed when creating local or national treatment guidelines.
3. Access, funding and reimbursement: Medicines will not generally be accessible to people with MS unless they are registered, quality-assured, procured, made available and are affordable at the point of care.
- The recommendations can provide the evidence underpinning advocacy activity aimed at making DMTs more accessible, funded and reimbursed, by demonstrating that this selection of DMTs should be available to all people with MS, wherever they live in the world.
This publication can be used by policymakers, patient advocacy groups, healthcare workers, and people with MS. If the recommendations are followed, they aim to ensure all people with MS have access to treatment and as a result, help to improve global health equity.
MSIF and its members are committed to improving access to MS healthcare for all people with MS, this is the first in a series of scientific publications we hope to share in the coming year.
Leveraging evidence to advance access to MS treatment
Evidence collection is an integral part of advocacy efforts and a powerful tool in influencing decision-makers to respond to your call for change. We hope this publication will support your efforts in building the evidence needed to advance your organisation’s national work to improve access to MS treatment.
The global MS movement has seen many advocacy successes that have led to improved access to MS healthcare. At the same time, there have been challenges and lessons learned. It is important to learn from one another and share our experiences.
Visit this webpage for a helpful starting point to explore different advocacy approaches and get inspired by the examples within the MS movement.
Further information
Access the full publication here: Pre-acceptance version of the publication (free to access): Recommendations-for-essential-medicines-for-MS-in-low-resource-settings-Nov-2024.pdf