As more treatments become available, patients will have more preferences and will play a more prominent role in directing choices.
As more treatments for multiple sclerosis (MS) become available, patients will have preferences for the therapies they select and will play a more prominent role in directing treatment choices.
Two disease-modifying therapies (DMTs) have been made available to treat patients with MS since 2009; a total of 6 DMTs currently are FDA-approved for treating relapsing-remitting or all relapsing forms of MS.1 Additional treatments for MS are in the pipeline, so assessing patients’ preferences is becoming increasingly important to neurologists who are treating patients with MS.
A report on which types of DMTs patients with MS prefer and the reasons behind their preferences is found in a survey study conducted by researchers at Friedrich-Alexander-UniversitÃ¤t Erlangen-NÃ¼rnberg, Germany, and published in Therapeutic Advances in Neurological Disorders.2
The researchers surveyed 156 patients with relapsing-remitting MS age 18 years and older, giving them 2 paper-based questionnaires that asked them about DMT preferences and collected information about their personal characteristics. The surveys took about 20 minutes to complete.
The survey results demonstrated that route of administration and treatment frequency influence patient preference more than adverse effects. Study participants preferred pills over injections, if treatment frequency and adverse effect frequency remained constant. However, participants preferred injections if pills had to be taken 3 times a day but injections were given only weekly. The patients also preferred injections when pills produced frequent adverse effects.
Patient characteristics also affected treatment choice. For example, adverse effects were a more important consideration for treatment-naÃ¯ve patients compared with DMT-experienced patients. Level of disability, as measured by the Expanded Disability Status Score, significantly increased the likelihood that patients would prefer pills and significantly decreased the likelihood that they would tolerate pills that confer adverse effects.
“Knowing patient preferences for DMTs may help the physician to propose a certain DMT,” lead author Dr Kathrin Utz told Neurology Times. “In a treatment-naÃ¯ve patient it may be more advisable to choose a DMT with less frequent side effects,” she said. “For more disabled patients a pill seems to be the more preferred option. The acceptance of a medication may also increase treatment adherence and thus treatment effects.”
Dr Utz further suggested that the study could help direct future treatments: “This knowledge may be helpful for patients and physicians to choose between DMTs. Moreover, the knowledge can be used to guide the development of new drugs.”
• As more DMTs become available for MS, patient preferences may in part dictate the therapy chosen.
• Most patients with MS prefer pills to injection, but they may choose injection if this reduces drug administration or if injections have fewer adverse effects.
• Patient characteristics, such as treatment experience and level of disability, also can affect DMT preferences.
1. Multiple Sclerosis Association of America. Long-Term Treatments for MS. http://www.mymsaa.org/about-ms/treatments/long-term/
2. Utz KS, Hoog J, Wentrup A, et al. Patient preferences for disease-modifying drugs in multiple sclerosis therapy: a choice-based conjoint analysis. Ther Adv Neurol Disord. 2014;7:263-275.