International Journal of Clinical Pharmacy

, Volume 35, Issue 6, pp 1229–1235 | Cite as

Treatment of multiple sclerosis in Germany: an analysis based on claims data of more than 30,000 patients

  • Roland WindtEmail author
  • Gerd Glaeske
  • Falk Hoffmann
Research Article


Background Multiple sclerosis (MS) is an incurable disease of the central nervous system. In addition to symptomatic treatment, immunomodulatory and immunosuppressant agents are used to prevent attacks and to influence the course of disease. Objective The goal of this study was to assess the drug use of MS patients in outpatient care considering gender-related and regional differences. Setting We analyzed outpatient claims data of the single largest German health insurance fund (about 9 million insurants) for the year 2010. Method Patients with MS were identified by outpatient ICD-10-GM-diagnosis code ‘G35’. All age groups were included. MS-specific drug use was analysed for those patients, considering regional and gender-related differences in specific drug prescriptions. Main outcome measure Prescription rates for symptomatic treatment, relapse treatment and disease-modifying treatment. Results 31,248 patients with a diagnosis of MS were identified (0.35 % of all insurants). Their mean age was 50.4 ± 14.1 years, 77.7 % of them were female. 37.6 % of the included patients were treated with disease-modifying drugs, 23.4 % got prescriptions for corticosteroids, drugs of choice for relapse therapy, and 63.1 % received symptomatic treatment as defined in the study. Women with MS were prescribed significantly more non-steroidal anti-inflammatory drugs, urinary antispasmodics, antidepressants, tranquilizer and hypnotic drugs. Regional variations were also found, with highest usage of disease-modifying drugs in eastern regions of Germany. Conclusion This study gives an insight into the treatment of MS in daily practice by using the claims data of a large health insurance company. The prescription rate for disease modifying drugs was relatively low suggesting that early treatment was not routine practice. Furthermore, the results indicated that women with MS were more likely to receive treatment for psychiatric symptoms and pain.


Claims data Drug treatment Germany Health services research Immunomodulators Multiple sclerosis Routine data analysis 



We thank the BARMER GEK for the provision of the data.


A part of the analysis was financed by the BARMER GEK.

Conflicts of interest

The authors declare that they are involved in various projects funded by different health insurance funds. The authors alone are responsible for the content and writing of the article.


  1. 1.
    Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vecsei L, et al. The epidemiology of multiple sclerosis in Europe. Eur J Neurol. 2006;13(7):700–22.PubMedCrossRefGoogle Scholar
  2. 2.
    Kobelt G, Berg J, Lindgren P, Elias WG, Flachenecker P, Freidel M, et al. Costs and quality of life of multiple sclerosis in Germany. Eur J Health Econ. 2006;7(Suppl 2):S34–44.PubMedCrossRefGoogle Scholar
  3. 3.
    Sobocki P, Pugliatti M, Lauer K, Kobelt G. Estimation of the cost of MS in Europe: extrapolations from a multinational cost study. Mult Scler. 2007;13(8):1054–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Gold R, Montalban X. Multiple sclerosis: more pieces of the immunological puzzle. Lancet Neurol. 2012;11(1):9–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Crayton HJ, Rossman HS. Managing the symptoms of multiple sclerosis: a multimodal approach. Clin Ther. 2006;28(4):445–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med. 2000;343(13):938–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Flachenecker P, Stuke K, Elias W, Freidel M, Haas J, Pitschnau-Michel D, et al. Multiple sclerosis registry in Germany: results of the extension phase 2005/2006. Dtsch Arztebl Int. 2008;105(7):113–9.PubMedGoogle Scholar
  8. 8.
    Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, et al. The natural history of multiple sclerosis: a geographically based study I. Clin Course Disabil. Brain. 1989;112(Pt 1):133–46.Google Scholar
  9. 9.
    Giovannoni G. Management of secondary-progressive multiple sclerosis. CNS Drugs. 2004;18(10):653–69.PubMedCrossRefGoogle Scholar
  10. 10.
    Lipsy RJ, Schapiro RT, Prostko CR. Current and future directions in MS management: key considerations for managed care pharmacists. J Manag Care Pharm. 2009;15(9 Suppl A):S2–15.PubMedGoogle Scholar
  11. 11.
    Henze T, Rieckmann P, Toyka KV. Symptomatic treatment of multiple sclerosis. Multiple Sclerosis Therapy Consensus Group (MSTCG) of the German Multiple Sclerosis Society. Eur Neurol. 2006;56(2):78–105.PubMedCrossRefGoogle Scholar
  12. 12.
    Wiendl H, Toyka KV, Rieckmann P, Gold R, Hartung HP, Hohlfeld R. Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol. 2008;255(10):1449–63.PubMedCrossRefGoogle Scholar
  13. 13.
    Havla J, Kumpfel T, Hohlfeld R. Aktuelle Diagnostik und Therapie der Multiplen Sklerose. Dtsch Med Wochenschr. 2012;137(17):894–9.PubMedCrossRefGoogle Scholar
  14. 14.
    DGN. Diagnosis and treatment of multiple sclerosis (in German). Available from: Accessed 21 June 2013.
  15. 15.
    Sellebjerg F, Barnes D, Filippini G, Midgard R, Montalban X, Rieckmann P, et al. EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses. Eur J Neurol. 2005;12(12):939–46.PubMedCrossRefGoogle Scholar
  16. 16.
    Mäurer M, Dachsel R, Domke S, Ries S, Reifschneider G, Friedrich A, et al. Health care situation of patients with relapsing-remitting multiple sclerosis receiving immunomodulatory therapy: a retrospective survey of more than 9000 German patients with MS. Eur J Neurol. 2011;18(8):1036–45.PubMedCrossRefGoogle Scholar
  17. 17.
    Wild F. [Pharmaceutical prescription for multiple sclerosis : evaluation of pharmaceutical consumption at private health insurance.] (in German). Nervenarzt. 2013;84(2):202–8.PubMedCrossRefGoogle Scholar
  18. 18.
    WHO. Guidelines for ATC classification and DDD assignment 2012. Oslo 2011.Google Scholar
  19. 19.
    Kappos L, Heun R, Mertens HG. A 10-year matched-pairs study comparing azathioprine and no immunosuppression in multiple sclerosis. Eur Arch Psychiatry Clin Neurosci. 1990;240(1):34–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Margolis JM, Fowler R, Johnson BH, Kassed CA, Kahler K. Disease-modifying drug initiation patterns in commercially insured multiple sclerosis patients: a retrospective cohort study. BMC Neurol. 2011;11:122.PubMedCrossRefGoogle Scholar
  21. 21.
    Mikol DD, Barkhof F, Chang P, Coyle PK, Jeffery DR, Schwid SR, et al. Comparison of subcutaneous interferon beta-1a with glatiramer acetate in patients with relapsing multiple sclerosis (the REbif vs Glatiramer Acetate in Relapsing MS Disease [REGARD] study): a multicentre, randomised, parallel, open-label trial. Lancet Neurol. 2008;7(10):903–14.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Connor P, Filippi M, Arnason B, Comi G, Cook S, Goodin D, et al. 250 μg or 500 μg interferon beta-1b versus 20 mg glatiramer acetate in relapsing-remitting multiple sclerosis: a prospective, randomised, multicentre study. Lancet Neurol. 2009;8(10):889–97.PubMedCrossRefGoogle Scholar
  23. 23.
    Marriott JJ, O’Connor PW. Lessons learned from long-term multiple sclerosis treatment trials. Mult Scler. 2010;16(9):1028–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Windt R. Multiple Sklerose. BARMER GEK Arzneimittelreport 2010. Germany: Asgard; 2010, ISBN 978-3943744675. pp. 124–36.Google Scholar
  25. 25.
    Hoffmann F, Icks A. [Structural differences between health insurance funds and their impact on health services research: results from the Bertelsmann Health-Care Monitor] (in German). Gesundheitswesen. 2012;74(5):291–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Stuke K, Flachenecker P, Zettl UK, Elias WG, Freidel M, Haas J, et al. Symptomatology of MS: results from the German MS Registry. J Neurol. 2009;256(11):1932–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Pittock SJ, Mayr WT, McClelland RL, Jorgensen NW, Weigand SD, Noseworthy JH, et al. Change in MS-related disability in a population-based cohort: a 10-year follow-up study. Neurology. 2004;62(1):51–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Burton JM, O’Connor PW, Hohol M, Beyene J. Oral versus intravenous steroids for treatment of relapses in multiple sclerosis. Cochrane Database Syst Rev. 2009;3:CD006921.PubMedGoogle Scholar
  29. 29.
    Andersson PB, Goodkin DE. Glucocorticosteroid therapy for multiple sclerosis: a critical review. J Neurol Sci. 1998;160(1):16–25.PubMedCrossRefGoogle Scholar
  30. 30.
    Heesen C, Kasper J, Kopke S, Richter T, Segal J, Muhlhauser I. Informed shared decision making in multiple sclerosis–inevitable or impossible? J Neurol Sci. 2007;259(1–2):109–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Köpke S, Heesen C, Kasper J, Mühlhauser I. Steroid treatment for relapses in multiple sclerosis—the evidence urges shared decision-making. Acta Neurol Scand. 2004;110(1):1–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Loikas D, Wettermark B, von Euler M, Bergman U, Schenck-Gustafsson K, et al. Differences in drug utilisation between men and women: a cross-sectional analysis of all dispensed drugs in Sweden. BMJ Open. 2013;3:e002378.Google Scholar
  33. 33.
    Anthony M, Lee KY, Bertram CT, Abarca J, Rehfeld RA, Malone DC, et al. Gender and age differences in medications dispensed from a national chain drugstore. J Womens Health (Larchmt). 2008;17(5):735–43.CrossRefGoogle Scholar
  34. 34.
    Johnell K, Fastbom J. Gender and use of hypnotics or sedatives in old age: a nationwide register-based study. Int J Clin Pharm. 2011;33(5):788–93.PubMedCrossRefGoogle Scholar
  35. 35.
    Kern WV, de With K, Nink K, Steib-Bauert M, Schroder H. Regional variation in outpatient antibiotic prescribing in Germany. Infection. 2006;34(5):269–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Muller-Nordhorn J, Kulig M, Binting S, Voller H, Krobot KJ, Willich SN. Regional variation in medication following coronary events in Germany. Int J Cardiol. 2005;102(1):47–53.PubMedCrossRefGoogle Scholar
  37. 37.
    Bensing C, Kleinfeld A. Medikamentöse Therapie der frühen rheumatoiden Arthritis. Monitor Versorgungsforschung. 2009;2(3):10–1.Google Scholar
  38. 38.
    Windt R, Glaeske G, Hoffmann F. Versorgung mit TNF-alpha-Blockern und regionale Unterschiede im Jahr 2010. Z Rheumatol. 2011;70(10):874–81.PubMedCrossRefGoogle Scholar
  39. 39.
    Erler A, Beyer M, Muth C, Gerlach FM, Brennecke R. [Garbage in—garbage out? Validity of coded diagnoses from GP claims records] (in German). Gesundheitswesen. 2009;71(12):823–31.PubMedCrossRefGoogle Scholar
  40. 40.
    Hein T, Hopfenmuller W. Hochrechnung der Zahl an Multiple Sklerose erkrankten Patienten in Deutschland. Nervenarzt. 2000;71(4):288–94.PubMedCrossRefGoogle Scholar
  41. 41.
    DIMDI (German Insitute of Medical Documentation and Information). ATC-Classification System with Defined Daily Doses. Available from: Accessed 27 June 2013.

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  1. 1.Centre for Social Policy Research (ZeS)University of BremenBremenGermany

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