Five questions for … Dr. Annette Langer-Gould
Annette Langer-Gould, MD, PhD, is a translational neuroscientist with the Southern California Permanente Medical Group. She treats people with multiple sclerosis (MS) at the Kaiser Permanente Los Angeles Medical Center.
Dr. Langer-Gould joined Kaiser Permanente in 2009. Her research aims to deepen understanding of MS while improving quality of care. Recently, she co-authored an editorial in Neurology urging the medical community to embrace a low-cost medication that could improve care for many patients.
Why does MS treatment need to change?
MS is a disease that affects the brain and spinal cord, often leading to permanent disability. It cannot be cured. But medications can help reduce the risk of disability. People with more aggressive disease benefit from stronger medications. However, at least in the United States, many cannot afford the co-pays. Sometimes they do not get the treatment they need and become disabled.
At Kaiser Permanente Southern California, we have designed a multifaceted solution to this problem. Our MS Treatment Optimization Program ensures that more people with relapsing disease receive highly effective medications as early in the disease course as possible.
Key to the program is our increased use of a medication called rituximab. This drug is more traditionally used for cancer and other diseases, but it is also safe and highly effective for relapsing MS. Importantly, it costs much less than existing options.
Many insurance carriers in the United States and Europe limit coverage of rituximab for treating MS, citing lack of regulatory approval. But that may be changing. The World Health Organization now lists it as an essential medicine for MS. I hope others will follow. Widespread use could have huge benefits for patients and reduce inequities.
How has your research led you to push for a shift?
A study we published in 2022 found that relapse rates plummeted at Kaiser Permanente Southern California during our initial rollout of the MS Treatment Optimization Program between 2012 and 2018. Meanwhile, thanks in part to the lower cost of rituximab, the cost of treatment has fallen. And our patients say they love this medication. In addition to being effective and affordable, it is long-lasting, so they do not need to come to the office as often. That also means more people tend to stick with treatment over time.
What’s more, research we conducted in collaboration with Sweden showed similar successes for patients, leading the country’s health care system to approve rituximab for MS. It really seems to be a game changer.
What drew you to study MS?
I began seeing MS patients as a medical resident and PhD student at Stanford University. Because MS is a chronic disease, this provided an opportunity to build rewarding, long-term relationships with patients. I also realized studying MS would be a chance to fight for underserved and under-studied patients. My first claim to fame was discovering that breastfeeding reduces the risk of relapse after pregnancy.
Why did you choose to come to Kaiser Permanente?
I always say that I wanted to see patients, do research, stay married, and see my kids. At the time, Kaiser Permanente was the only place that aligned with my goals. I have not been disappointed. Our success with our MS program highlights what I love about Kaiser Permanente’s commitment to evidence-based medicine. We are improving treatment based on evidence, and we hope the rest of the country follows.
What do you like to do in your spare time?
I love hiking, swimming, cooking, spending time with family and friends, and going to music festivals, like Coachella and Ohana.
Image: Dr. Langer-Gould with her sons Ethan (left) and Teddy (right) on the Troll Road during a family trip to Norway.