Influence of physicians' risk perception on switching treatments between high- efficacy and non-high-efficacy disease‑modifying therapies in multiple sclerosis.

BACKGROUND

The decision of initiating treatment for multiple sclerosis (MS) with a high-efficacy DMT (HE DMT) or non-high-efficacy DMT (non-HE DMT) is influenced by several factors, including risk perception of patients and physicians.

OBJECTIVE

Investigate the influence of physicians' risk perception on decision-making when switching treatments for MS and the reasons for switching.

METHODS

Data were drawn from the Adelphi Real-World MS Disease-Specific Program (a retrospective survey) and analysis included people with RMS identified between 2017- 2021.

RESULTS

Of 4129 patients with reasons for switch available, 3538 switched from non-HE DMT and 591 from HE DMT. Overall, 4.7% of patients were switched treatment by their physicians due to the risk of malignancies and infections including PML risk. The proportion of switches that were made due to the risk of PML were 23.9% in the HE DMT and 0.5% in the non-HE DMT groups. The top reasons for switching were relapse frequency (non-HE DMT vs HE-DMT: 26.8% vs 15.2%), lack of efficacy (20.9 vs 11.7) and increased number of MRI lesions (20.3% vs 12.4%).

CONCLUSIONS

Physicians' risk perception of malignancies and infection excluding PML was not a leading factor when switching treatment. The risk of PML was a key factor, especially for switching patients from HE DMTs. In both groups, lack of efficacy was the key contributing factor for switching. Initiating the treatment with HE DMTs may potentially reduce the number of switches due to sub-optimal efficacy. These findings might help physicians to engage more in discussions with patients about the benefit/risk profile of DMTs.

Informations de copyright

Copyright © 2023. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of Competing Interest Tarunya Arun has nothing to disclose. Carlos Capela has received consulting fees from Janssen, Merck and Roche, has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Almirall, Biogen, Bristol Myers Squibb, Janssen, Merck, Novartis, Roche, Sanofi-Genzyme and Teva, has received support for attending meetings and/or travel from Almirall, Bayer, Merck, Novartis, Roche, Sanofi-Genzyme and Teva, has participated on a Data Safety Monitoring Board or Advisory Board for Biogen, Janssen, Merck, Novartis, Roche and Sanofi-Genzyme. Guy Laureys and/or his employer (UZ Ghent) have received financial compensation for congress attendance, consultancy, research and education by Almirall, Biogen, Celgene, Bristol Myers Squibb, Novartis, Roche, Sanofi, Teva. Pietro Iaffaldano and/or his institution has received medical writing support for present manuscript from Novartis, has received grants from Novartis, Biogen and Roche; has received consulting fees from Novartis, Biogen, Sanofi, genzyme, BMS, Merck and Roche; has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Roche, Biogen, Sanofi and Merck; support for attending meetings and/or travel from Biogen, Sanofi and Merck and participated on a data safety monitoring board or advisory board for Novartis, Biogen, Sanofi, Genzyme, BMS, Merck and Roche. Eddie Jones is an employee of Adelphi Real World. Adelphi Real World received funds from Novartis in exchange for access to the MS DSP data set that was used for analysis. Eddie Jones did not receive any funding directly from Novartis. Patricia Dominguez-Castro, and Simone Hiltl are employees of Novartis Pharma AG. Gustavo Seifer was an employee of Novartis Pharma AG at the time of study design, execution, interpretation and submission. Rainel Sanchez-de la Rosa was an employee of Novartis Pharma AG at the time of study design and execution.