Providers weigh treatment logistics in selecting DMTs for MS patients

In real world, dose frequency, other factors count alongside safety, efficacy

Andrea Lobo, PhD avatar

by Andrea Lobo, PhD |

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A person weighs two medicine choices, one suspended above each hand: a capsule versus a syringe.

Certain clinical attributes of disease-modifying therapies (DMTs), such as safety and the medication’s impact on risk of relapse and disability progression, are considered important by healthcare providers in selecting the appropriate treatment for people with multiple sclerosis (MS), according to a new survey study.

However, a study experiment also found that logistical factors — including dosing frequency, time for dose adjustment, a medicine’s specific formulation, and even the volume of patient calls to the clinic — often are of similar importance for clinicians in choosing among DMTs for the MS patients under their care.

“This study suggests that the thoughtful selection of an appropriate therapy from a range of good therapy options weighs both clinical and logistical attributes,” researchers wrote.

“In addition to clinical attributes like efficacy and safety, [healthcare providers] aim to minimize potential real-world logistical burdens on their patients and practice,” the team added.

The study, “Real-world treatment preferences among health care providers in the United States in selecting disease modifying therapies for patients with multiple sclerosis: a discrete choice experiment,” was published in the Journal of Medical Economics.

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Healthcare providers can choose from over 20 DMTs

More than 20 disease-modifying therapies — known as DMTs for short — are currently approved for the treatment of MS. These therapies can reduce disease activity and slow the accumulation of MS disability by modulating the immune system and reducing the inflammation that causes the disorder.

Generally speaking, medication decisions are based on discussions between patients and their healthcare providers that take into consideration not only the clinical aspects of the condition, such as disease type and disease activity, but also the preferences of each patient.

However, each therapy has its own mechanism, route of administration, and safety and efficacy profile, which can make treatment decisions quite complex.

Although previous studies demonstrated that healthcare providers and MS patients consider certain clinical properties important for treatment selection, non-clinical factors also are thought to play a significant role.

Now, a team of researchers at Biogen and Trinity Life Sciences set out to better understand the factors influencing MS treatment choice by clinicians.

The team collected data from 145 healthcare providers, including 100 neurologists and 45 advanced practiced clinicians (APCs) accredited in neurology. The APCs comprised 30 nurse practitioners and 15 physician assistants.

Participants were recruited from an online panel representative of the U.S. healthcare provider population. All had experience in direct care of MS patients using DMTs. On average, each provider had to see at least 25 MS patients per month, and at least five currently taking DMTs.

Among the final study population, the neurologists surveyed had been practicing for an average of 18.6 years and prescribing MS treatments for 17.2 years. APCs, meanwhile, were practicing for a mean of 11.6 years and prescribing DMTs for 7.7 years.

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Questionnaire reveals importance of logistics

A web-based questionnaire, which took about 45 minutes to complete, was used to directly assess the most important attributes these providers considered when selecting a DMT.

Data from this survey showed that treatment safety and efficacy, namely the reduction in the risk of relapses and disability progression, were the top attributes contributing to overall treatment selection.

Other factors, such as patient monitoring, time needed for treatment initiation, number of patient phone calls to the clinic, or need for dose adjustments (dose titration), were considered less important by healthcare providers in answering the survey.

To learn more, the team also conducted a discrete choice experiment in which practitioners were presented with hypothetical treatment profiles and asked to select the most preferred DMT, the least burdensome to the patient, the DMT that would enable optimal adherence, and the least burdensome to the provider and their practice.

This experiment enabled researchers to indirectly determine some of the factors that also play a role when clinicians are selecting an MS DMT.

An oral product with strong efficacy and good safety profile that also has a favorable dose titration [and] a good GI tolerability profile … can reduce burden to both [healthcare providers] and patients.

These results showed that clinical attributes of efficacy and safety, as well as gastrointestinal or GI tolerability, were all important factors in making treatment decisions. The mean relative attribute importance was 16.5% for effectiveness, 9.8% for safety, and 9.4% for gastrointestinal tolerability, the data showed.

However, contrasting with the questionnaire, logistical attributes also were important, according to the experiment. These factors included dose frequency, which had a relative importance of 17.5%, and dose titration, at 10.3%. A DMT’s formulation had a relative important of 9.4%, while the volume of patient calls to the clinic was 9.1%.

More specifically, healthcare providers preferred treatments that required less frequent dosing (every six months), allowed flexibility for dose titration (from one to four weeks), and were orally administered. Also preferred were treatments that required less phone calls to the clinic, and DMTs that had better efficacy, safety, and tolerability profiles.

“An oral product with strong efficacy and good safety profile that also has a favorable dose titration [and] a good GI tolerability profile … can reduce burden to both [healthcare providers] and patients,” the researchers wrote.

According to the team, based on the attributes preferred by healthcare providers to treat MS patients, the oral treatment Vumerity (diroximel fumarate), which is marketed by Biogen, may be good a therapy of choice for healthcare providers to prescribe.