In general, patients with multiple sclerosis (MS) choose their disease-modifying drug (DMD) treatment based on considerations of effectiveness and potential side effects. But the weight they assign to these considerations can differ widely, making it important they are part of treatment decisions, especially regarding DMDs.
These findings are in the report, “Identification and Prioritization of Important Attributes of Disease-Modifying Drugs in Decision Making among Patients with Multiple Sclerosis: A Nominal Group Technique and Best-Worst Scaling,” published in the journal PLoS One.
Currently, many different DMDs, aiming to slow relapse rates and disease progression in patients with relapsing-remitting MS (RRMS), are available in the U.S. and Europe (14 are FDA-approved and 11 by the U.K.’s health service) and new ones are being developed. But the effectiveness of DMDs can vary among individuals, as can unwanted effects. For this reason, patients have to play a role in deciding among options, including the option of no DMD treatment at all.
Understanding patients’ preferences regarding DMDs and involving them in the clinical decision-making process can improve both the relationship between health professionals and patients, and the likelihood of treatment adherence over time.
Researchers asked three groups of RRMS patients (19 in total) with experience in choosing DMDs to compile a preliminary list of DMD attributes they considered important. Based on this information, the team developed a survey that assigned a scale (from best to worst) to these attributes, then asked a larger patient group (185 patients) to choose the most and least important attributes. The researchers used this survey to estimate the mean relative importance scores (RIS) for each attribute.
Patients ranked the treatment’s effect on disease progression highest, followed by quality of life, relapse rate, severity of side effects, and relapse severity. Mode, frequency or duration of administration, in contrast, ranked rather low.
Analyses within patient subgroups, however, showed that preferences differed. For instance, side effect-related attributes were more important for patients who had never before used a DMD at the time of the survey (54 patients) compared to those who had (131). Also, DMD safety was significantly more important for patients diagnosed with MS for more than 4.6 years compared to patients with shorter disease durations.
Men were significantly more concerned about the influence of DMD use on their lifestyle and its effect on life expectancy than women, based on the RIS they assigned these points.
“[T]his study shows that patients with RRMS … find beneficial and unwanted effects to be the most important DMD attributes in making decisions about DMD treatment, more important than usability issues with taking the DMD,” the authors wrote. “The effect on disease progression and quality of life were the most important attributes. However, this study also recognizes the heterogeneity in preferences of patients.”
And, they concluded: “When having to make a decision about DMD treatment, clinicians should be aware of what the average patient finds important and incorporate information on these attributes in the education for the shared decision making process. However, person-centered clinical decision making requires eliciting the individual patient’s preferences for DMD treatment at the point of the decision.”