OBJECTIVES: Intrathecal drug therapy via implanted pump for treatment of spasticity and chronic pain is highly varied and may have significant implications for patient outcomes. The objectives of this study were to: 1) characterize factors that influence real-world usage of these drugs, and 2) identify key differences and similarities in clinical practice, along with unmet needs across global markets. METHODS: A cohort of 96 health care providers (HCPs) was surveyed across 6 countries, Canada (16), France (15), Italy (10), Germany (20), UK (15), and US (20).  The HCPs included physicians and nurses caring for patients with intrathecal pumps across multiple specialties. RESULTS:

• Compounded vs Manufacturer-prepared: While respondents cited continued need for compounded drugs (66%), comparable manufacturer-prepared drugs, if available, were preferred by at least 33% (highest in Germany, 45%), even at a higher procurement cost (20%). Over 25% respondents expressed concern over compounded drugs, including limited regulation, variable efficacy, and potential for sterility issues.
• Dosage: Depending on the drug, from 60% to 90% of respondents expressed interest in new manufacturer-prepared doses. 
• Packaging Format: Over 77% respondents preferred pre-filled syringes over ampules (18%) or vials (5%), largely due to ease of use and sterility. Despite this preference, 65% of respondents were concerned about the associated higher cost of prefilled syringes.  

CONCLUSIONS: This cross-sectional survey identified consistent themes across the 6 markets. Unmet needs identified included opportunities for manufacturer-prepared drugs, new packaging forms, and new concentrations. Overall, clinicians’ preferences for drugs delivered via intrathecal pumps were driven by patient-related health factors.