OBJECTIVES: Prolonged-release (PR) fampridine is approved for the improvement of walking in adult patients with Multiple Sclerosis (MS) with walking disability (EDSS 4-7). Physiotherapy has also been referenced as an alternative treatment option for walking in people with MS (PwMS), and we therefore investigated the association between PR-fampridine and physiotherapy use in clinical practice.

METHODS: We used data for patients aged 18-65 years and EDSS 4-7 from a 16-country European cross-sectional study of PwMS (n=6,062) and the 2016 Adelphi MS Disease Specific Programme cross-sectional database from 5 European countries and the United States (n=1,584). Patients were divided according to PR-fampridine use and the percentage receiving physiotherapy in both groups calculated. PR-fampridine users and non-users were compared using a multivariable logistic regression model adjusting for annual relapse rate, age, gender, EDSS, disease duration, and DMT use.

RESULTS: The percentage of patients using physiotherapy was higher among patients who also used PR-fampridine in both datasets. In the cross-sectional study, 862 (14.2%) used PR-fampridine and 2,648 (43.68%) reported using physiotherapy. Physiotherapy was used by 58.47% of PR-fampridine-users compared with 41.23% of non-users (multivariate adjusted odds ratio of 1.77 (95% confidence interval [CI]: 1.50-2.09, P<0.0001). Among patients in the Adelphi database, 240 (15.2%) used PR-fampridine, the corresponding percentage of physiotherapy use among PR-fampridine users and non-users was 82.5% and 59.97%, respectively, with an odds ratio of 1.87 (95% CI 1.04-3.36, P=0.037). Despite the overall correlation between PR-fampridine and physiotherapy, there is a significant cross-country variation in this correlation, mainly dependent on availability of PR-fampridine and access to physiotherapy.

CONCLUSIONS: In two international MS databases, PR-fampridine appears to be used in combination with physiotherapy, albeit with country variability, rather than as a mutually exclusive alternative. Further research is required to confirm whether the combination of physiotherapy with PR-fampridine treatment is associated with improved walking outcomes in patients with MS.