SAN DIEGO—A drug’s safety profile and mode of administration are the most important considerations for physicians and patients evaluating disease-modifying therapies for multiple sclerosis (MS). However, for neurologists, drug efficacy is more important than the risk of adverse events, while the opposite is true for patients, according to a study presented at the Fourth Cooperative Meeting of the Consortium of MS Centers and the Americas Committee for Treatment and Research in MS.
Reduction in annual relapse rate was the third most important criterion for physicians choosing an MS therapy. The likelihood of flu-like symptoms and the risk of herpes virus infection, however, were more important for patients than the reduction in annual relapse rate. The amount of time that a drug had been on the market was the least important attribute for physicians and patients.
Evaluating MS Therapy Preferences
Aaron Miller, MD, Professor of Neurology at the Mount Sinai School of Medicine in New York City, and colleagues surveyed 504 patients and 100 neurologists to determine the relative influence that efficacy and tolerability attributes have on their selection of MS therapies. Participants were randomly assigned to one of two Internet-based stated-choice questionnaires that the researchers had developed to evaluate participants’ preferences.
The investigators performed univariate analysis to evaluate survey variables and analyzed stated-choice data with mixed logistic regression models, with the respondent as a random effect.
Dr. Miller’s group determined the relative importance of various drug attributes for the choice of medication, as well as the maximum acceptable risk.
Nearly 81% of patients were female, and the patients’ mean age was approximately 53. All patients had been diagnosed with MS. Approximately 78% of physicians were male, and 78% had been practicing for 11 years or more. A majority (51%) of physicians reported seeing between 15 and 30 patients with MS or clinically isolated syndrome per month.
Physicians Accept Greater Risk Than Patients
On average, patients were willing to accept a maximum risk of herpes virus infection of 1.9% for a 20% reduction in annual relapse rate. In contrast, physicians were willing to accept a 3.2% risk of herpes virus infection to achieve the same outcome. Patients were willing to accept a maximum risk of flu-like symptoms of 24.7% for a 20% reduction in annual relapse rate. Physicians were willing to accept a 100% risk of flu-like symptoms to achieve this outcome. The maximum acceptable risk of flu-like symptoms that physicians were willing to accept varied widely, however.
“The results of this study suggest a disconnect between MS patients and treating neurologists,” said Dr. Miller. “The variability in the attribute responses emphasizes the need for individualized discussions between health care providers and patients before deciding on any treatment choices,” he concluded.
—Erik Greb