Identification of patients with relapsing multiple sclerosis eligible for high-efficacy therapies

2021 ◽  
Author(s):  
José Meca-Lallana ◽  
Juan Antonio García-Merino ◽  
Sergio Martínez-Yélamos ◽  
Angela Vidal-Jordana ◽  
Lucienne Costa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Expert Opinion ◽  
Second Line ◽  
High Efficacy ◽  
Clinical Evolution ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Relapsing Multiple Sclerosis ◽  
Selection Of

Relapsing multiple sclerosis (RMS) presents a highly variable clinical evolution among patients, and its management should be personalized. Although there is no cure at present, effective disease-modifying therapies (DMTs) are available. Selection of the most appropriate DMT for each patient is influenced by several clinical, radiological and demographic aspects as well as personal preferences that, at times, are not covered in the regulatory criteria. This may be a source of difficulty, especially in certain situations where so-called ‘high-efficacy DMTs’ (usually considered second-line) could be of greater benefit to the patient. In this narrative review, we discuss evidence and experience, and propose a pragmatic guidance on decision-making with respect to the indication and management of high-efficacy DMT in adult patients with RMS based on expert opinion.

scholarly journals Patients experiences with multiple sclerosis disease-modifying therapies in daily life – a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Sippel ◽  
Karin Riemann-Lorenz ◽  
Jutta Scheiderbauer ◽  
Ingo Kleiter ◽  
Rebecca Morrison ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Daily Life ◽  
Interview Study ◽  
Disease Modifying Therapies ◽  
Qualitative Interview Study ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Abstract Background Besides coping with a disease with many uncertainties, people with relapsing-remitting multiple sclerosis face complex decisions concerning disease-modifying therapies (DMTs). In an interview study, we aimed to assess patients’ experiences with DMTs. Methods Problem-centred interviews were conducted with 50 people with relapsing-remitting multiple sclerosis in Germany using maximum variation sampling and covering all licensed DMTs. Data were analysed thematically using deductive and inductive categories. Results 47 of 50 patients had treatment with at least one of the approved DMTs. The main themes were: (1) starting a DMT, (2) switching to another DMT, (3) discontinuing a DMT, and (4) multiple sclerosis without starting a DMT. Different intercorrelated factors influenced the decision-making processes for or against a DMT. Individual experiences with DMTs in daily life contained the effort in administration, success, and failure of DMTs, coping strategies and well-being without DMTs. The decision-making process for or against a DMT and the use of those treatments can be understood as a constant, continually shifting process, complicated by different factors, which change over time. Experiences with DMTs were characterized by attempts to handle uncertainty and to (re)gain control and integrate adaptivity into one’s life. Conclusions The study provides a rich and nuanced amount of patients’ experiences with DMTs. The findings demonstrate the importance for practitioners to look at current life circumstances of patients with multiple sclerosis when recommending a DMT and to promote and enable patients to make informed decisions.

Perspectives of individuals with multiple sclerosis on discontinuation of disease-modifying therapies

2019 ◽  
Vol 26 (12) ◽  
pp. 1581-1589
Author(s):  
Marisa P McGinley ◽  
Philip A Cola ◽  
Robert J Fox ◽  
Jeffrey A Cohen ◽  
John J Corboy ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Structural Equation ◽  
Descriptive Analysis ◽  
Equation Modeling ◽  
Decision Making Process ◽  
Inclusion Criteria ◽  
Research Committee ◽  
Disease Modifying Therapies ◽  
Disease Modifying

Background: Therapeutic research in multiple sclerosis (MS) has focused on the development of treatments with little investigation regarding the possibility of discontinuation of disease-modifying therapies (DMTs). Objective: To understand the opinion of individuals with MS concerning stopping DMTs and the factors that influence the decision-making process. Methods: A mixed method approach was used starting with three focus groups from which a survey was developed. This survey was sent to 1000 participants in the North American Research Committee on Multiple Sclerosis registry who met inclusion criteria (age ⩾45 years; on most recent DMT for ⩾5 years). Descriptive analysis and structural equation modeling were used. Results: Of 1000 participants receiving the survey, 377 provided complete responses and met inclusion criteria. Only 11.9% of participants reported that if their disease was considered stable, they would consider coming off medications. A high level of external locus of control in influential others such as physicians significantly decreased the likelihood of considering discontinuation. Conclusions: Most individuals with MS report being unlikely to consider stopping MS therapy if their disease was considered “non-active.” As the results of studies concerning DMT discontinuation are obtained, information from providers will be an important part of individuals’ decision-making process.

Initial high-efficacy disease-modifying therapy in multiple sclerosis

Neurology ◽  
2020 ◽  
Vol 95 (8) ◽  
pp. e1041-e1051 ◽  
Author(s):  
Mathias Due Buron ◽  
Thor Ameri Chalmer ◽  
Finn Sellebjerg ◽  
Ismael Barzinji ◽  
Jeppe Romme Christensen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Lower Probability ◽  
Matched Sample ◽  
Class Iii ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
Baseline Activity ◽  
First Relapse ◽  
Disease Modifying ◽  
Edss Score

ObjectiveTo determine the effectiveness of high-efficacy disease-modifying therapies (heDMTs) vs medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naive patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry.MethodsWe identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity score matched sample of patients starting meDMT.ResultsWe included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval [CI] 10.4%–23.0%) and 30.1% (95% CI 23.1%–37.1%) for heDMT and meDMT initiators, respectively (hazard ratio [HR] 0.53, 95% CI 0.33–0.83, p = 0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37–0.67). Results were similar after pairwise censoring and in subgroups with high baseline activity, diagnosis after 2006, or information on baseline T2 lesion load.ConclusionWe found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT.Classification of evidenceThis study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.

scholarly journals Development and Evaluation of a Website With Patients Experiences of Multiple Sclerosis: A Mixed Methods Study

2021 ◽  
Author(s):  
Anna Sippel ◽  
Jutta Scheiderbauer ◽  
Désirée Eklund ◽  
Sigrid Arnade ◽  
Stephan Schmidt ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Mixed Methods ◽  
Health Care Professionals ◽  
Visual Information ◽  
Patient Experiences ◽  
Management Options ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Qualitative Responses

Abstract Background A variety of management options (e.g., disease-modifying therapy, lifestyle interventions, rehabilitation) are available for persons with relapsing-remitting multiple sclerosis (MS). Besides coping with the diagnosis, persons with MS have to make complex decisions, e.g., regarding disease-modifying therapies. In addition to factual information, reports of patient experiences may support other patients in their decision-making. Therefore, we developed a website presenting patient experiences illustrated by video, audio and text files. This study aimed to test the acceptability and usability of a website with patient experiences with MS. Methods A mixed-methods approach was applied. A total of 69 participants visited the German “Patient Experiences with MS (PExMS)” website and among them, 50 persons with MS and 6 experts completed an online survey. In total, 18 participants took part in telephone interviews or focus groups. Data from the survey were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Results Both quantitative and qualitative responses suggest that the PExMS website was viewed positively by patients and experts. 94% of persons with MS agreed that the information was comprehensible and reliable. 54% felt encouraged to share their health problems with others after having studied the website. 74% claimed to use the website if they had to make a decision regarding their health. Qualitative responses deduced from the website fell into 5 key themes: (1) web design, appearance, and functionality, (2) content, (3) usability, (4) satisfaction, and (5) loyalty. The search for persons of similar age and with comparable experiences was a major driving force to navigate the website. The material on the website was perceived as diverse, covering both positive and negative experiences in daily living with MS. All participants greatly appreciated having access to other people’s experiences online and judged the material on the website as particularly helpful in decision-making for disease-modifying therapies. Conclusions The findings suggest that the PExMS website might have the potential to be a useful source of audio-visual information for persons with MS. Given the lack of websites available to patients with experiential information, health care professionals may be encouraged to routinely inform patients about this website at regular appointments.

scholarly journals Sequencing of high-efficacy disease-modifying therapies in multiple sclerosis: perspectives and approaches

2018 ◽  
Vol 13 (11) ◽  
pp. 1871 ◽  
Author(s):  
Francois Grand′Maison ◽  
Michael Yeung ◽  
SarahA Morrow ◽  
Liesly Lee ◽  
Francois Emond ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
High Efficacy ◽  
Disease Modifying Therapies ◽  
Disease Modifying
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