Patient and Neurologist Preferences in the United States for Relapsing-Remitting Multiple Sclerosis Treatments: Findings from a Discrete Choice Experiment

Abstract

Background and Objective Relapsing-remitting multiple sclerosis (RRMS) is a chronic inflammatory disease associated with central nervous system dysfunction and accelerated brain volume loss (BVL). There exists a paucity of research examining the importance of BVL to patients and neurologists and exploring whether such preferences may differ between these two groups. This study sought to evaluate the preferences of patients and neurologists for RRMS treatments by considering benefits and risks associated with novel and common disease-modifying therapies (DMTs). Patients and Methods US patients diagnosed with non-highly active RRMS and US-based neurologists completed an online cross-sectional survey. A discrete choice experiment was used to assess patient and neurologist treatment preferences, with neurologists considering preferences for patients with non-highly active RRMS. Respondents chose between two treatment profiles with seven attributes identified in qualitative research: 2-year disability progression; 1-year relapse rate; rate of BVL; and risks of gastrointestinal symptoms, flu-like symptoms, infection, and life-threatening events. Attribute-level weighted preferences were estimated using a hierarchical Bayesian model. Results Analyses included 150 patients with non-highly active RRMS (mean age: 54 years) and 150 neurologists (65% in private practice). Among patients, the most important treatment attribute was reducing the rate of BVL, followed by reducing the risk of infection and risk of flu-like symptoms. In contrast, the most important treatment attribute among neurologists was reducing the risk of a life-threatening event, followed by slowing the rate of 2-year disability progression and risk of infection. Conclusion The findings highlight differences in treatment preferences between US patients and neurologists for non-highly active RRMS. The importance placed by patients on slowing the rate of BVL makes this a key topic that should be covered in the shared decision-making process.

Insights for Healthcare Providers on Shared Decision-Making in Multiple Sclerosis: A Narrative Review

“…When considering DMT treatment initiation, the attributes of efficacy, mode and frequency of administration, and side effect profiles are valued most by patients, according to a systematic review of 24 DMT studies in RRMS [ 51 ]. However, a USA-based survey of 150 patients and 154 neurologists, and a Dutch survey of 62 HCPs, found that HCPs may view logistical factors surrounding receipt of treatment as less important, and instead focus on prevention of disease (brain volume loss, relapse rate) and disability progression, as well as treatment safety, including risk of infection [ 48 , 52 ]. The MS in the 21st Century initiative of 14 HCPs and 11 patients with MS from Europe and the USA revealed that HCPs were concerned about the level of risk patients were willing to accept with their therapy [ 49 ].…”

Early use of high-efficacy therapies in multiple sclerosis in the United States: benefits, barriers, and strategies for encouraging adoption

“…Familiarity with established DMTs is an influential factor and can result in treatment inertia (reported in up to 70% of neurologists) and delays switching from an established to a newer therapy, especially among non-MS neurologists [ 127 , 136 ]. In the US, HCPs might be even more risk averse than patients due to different perspectives and clinical experience regarding potentially life-threatening safety risks, which can encourage more defensive medical practices out of concern for legal liability [ 137 , 138 ]. Updated long-term safety profiles, which can be communicated through continuing medical education and peer-to-peer events [ 10 , 139 ], will be critical for managing perceptions of HCPs and non-specialist neurologists in this regard.…”

“…Shared decision-making between HCPs and patients is a key component to improving acceptance of, and adherence to, DMTs [ 56 , 127 ]. It also allows patients to communicate their preferences, which may differ from those of HCPs [ 137 , 138 , 169 ]. For instance, route of administration is an important consideration for many patients [ 182 ].…”

Information Provision and Quality. A Pilot Study on Shared Decision-Making in Multiple Sclerosis

“…Two thirds of the patients are female [7]. In this study, people with MS (pwMS) were selected as a target group, since MS is a typical preferencesensitive condition, in which there are multiple treatments with similar efficacy but different safety profiles, follow-up and administrations [8]. The aim of the present study was to evaluate what type of information pwMS use in SDM and what are the sources of that information.…”