Opinions voiced by multiple sclerosis (MS) patients as to what they most want from, and like in, an MS treatment differ widely, although delaying progression and relapses — and minimizing serious side effects — clearly score high, according to new research from the University of British Columbia in Canada.
The study, “Quantitative analysis of multiple sclerosis patients’ preferences for drug treatment: a best-worst scaling study,“ published in the journal Therapeutic Advances in Neurological Disorders, shows how patients’ experiences shape their preferences, and gives physicians valuable insights into a patient’s likely priorities during visits.
Most MS patients today have a number of treatments to choose from, and can take into account such factors as frequency and route of drug administration (oral or injection) in addition to potential effectiveness and side effects.
Oral drug treatments are always preferred by developers and regulatory agencies, and it is generally assumed that patients feel the same way. But few studies have actually investigated what features of MS medication are valued by the patients themselves.
Initial focus groups and interviews with 23 MS patients — of whom 10 had relapsing disease but had not yet started treatment, eight had relapsing disease and had been treated for many years, and five had progressive MS — allowed researchers to identify those attributes most important to patients.
In the next step, 189 patients contributed with their views on treatment. Most were women with relapsing MS, who reported having stopped at least one earlier treatment for various reasons. At the time of the study, 45 percent of the participants were being treated.
Delaying disease progression by eight years was the most desirable therapy characteristic in the entire group, closely followed by delaying relapses for eight years.
Although daily injections were rated as the least preferred route of administration, the findings made it clear that the patients put a priority on delayed progression, symptom improvement, and severe side effects risk over easy-to-take, once-daily tablets.
However, when researchers took variables such as age, sex, treatment, and disease duration into account, the characteristics of “preferred treatment” differed widely. Dividing participants into five different classes based on their own characteristics showed that answers were linked to a patient’s particular circumstances.
In a group composed mostly of people with stable disease who had been treated for longer periods, delaying time to relapse and disease progression was highly valued; a second group, composed of individuals who had little experience with drug therapy and who had become more ill during the last year, believed that symptom control was more important. This group also voiced the strongest preference for daily tablet treatment.
A third group of people with a long experience in MS drugs was mostly concerned with the risk of severe side effects, while stable individuals in the fourth group focused on symptom improvement, but felt either yearly or monthly injection was a good treatment option. A stable group of patients in the fifth group also rated injection treatment as a good choice.
In all, it becomes obvious that earlier experiences shaped the preferences of patients — a finding that physicians should take into account when planning treatment together with their patients.