NATIONAL HARBOR, MD—Patients and prescribers agree that efficacy is the highest priority in decision making for first-line multiple sclerosis (MS) treatment, according to the results of an online survey reported at the 2016 CMSC Annual Meeting. Preferences were similar across segments of patient age categories, sex, education, insurance, and disease severity. Furthermore, prescribers place higher importance on the risk of serious side effects than do patients for first-line disease-modifying treatments (DMTs).
Edward J. Fox, MD, PhD
“Even though this study suggests that patients and neurologists prefer high-efficacy agents, real-world practice and market share of DMTs do not reflect this preference,” said Edward J. Fox, MD, PhD, a neurologist at Central Texas Neurology Consultants in Round Rock, Texas, and his coauthors. “Knowledge of preferred attributes for first-line treatment from the patient and neurologist perspectives can help to better inform communication regarding treatment decision making.”
To evaluate preferences for features of first-line DMTs among patients with relapsing-remitting MS and neurologists, Dr. Fox and his coinvestigators used PatientsLikeMe, an online, patient-powered social networking community, to recruit patients. Neurologists were recruited from the WebMD network. Maximum Difference Scaling (MDS), a type of best–worst scaling, was used to design online choice experiments in which respondents were shown a series of items and asked to indicate what they consider the most and least important factor when selecting a DMT. The factors included efficacy parameters (ie, slowing of disability progression, prevention of new MRI lesions, and reduction of relapse frequency), risk of serious side effects, tolerability, route of administration (ie, oral, injectable, infusion), cost, and neurologist recommendation.
A total of 193 patients and 225 neurologists responded. Preferences among patients and neurologists were similar. Items related to efficacy were of high importance among both groups. For both patients and neurologists, the items related to efficacy were preferred similarly, in decreasing order of importance: slowing disability progression, decreasing relapse frequency, and preventing new MRI lesions.
For first-line treatment selection, neurologists considered risk of serious side effects of higher importance than preventing new MRI lesions, but of lower importance than slowing disability progression or reducing relapse severity. Patients ranked the risk of serious side effects as of average importance, compared with the three efficacy items.
Patients and neurologists viewed tolerable side effects as an important factor after efficacy and safety in first-line and switch DMT preference. In both groups, parenteral drug administration was least preferred, in comparison with all other factors.
This study was supported by Novartis Pharmaceuticals.
—Glenn S. Williams