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High-Efficacy Disease-Modifying Therapies in People with Relapsing–Remitting Multiple Sclerosis: The Role of Risk Attitude in Treatment Decisions

Author

Listed:
  • Jorge Maurino

    (Roche Farma)

  • Javier Sotoca

    (Hospital Universitari Mútua de Terrassa)

  • Ángel P. Sempere

    (Hospital General Universitario de Alicante)

  • Luis Brieva

    (Hospital Universitari Arnau de Vilanova)

  • Carlos López de Silanes

    (Hospital Universitario de Torrejón)

  • Ana B. Caminero

    (Complejo Asistencial de Ávila)

  • María Terzaghi

    (University of Toronto)

  • Julia Gracia-Gil

    (Complejo Hospitalario Universitario de Albacete)

  • Gustavo Saposnik

    (University of Toronto
    University of Toronto
    University of Zurich)

Abstract

Background Risk attitude is defined as the willingness to tolerate risk to achieve a greater expected return. Limited information is available on how relapsing–remitting multiple sclerosis people’s perceptions about disease trajectory and risk attitude may influence treatment choices. Methods A non-interventional study applying principles of behavioral economics was conducted to assess willingness to receive unwarranted high-efficacy disease-modifying therapy (DMT) according to best-practice guidelines. People with relapsing–remitting multiple sclerosis (PwRRMS) according to 2010 McDonald criteria completed a survey on symptom severity, risk preferences, and management of simulated case scenarios mimicking the current treatment landscape. PwRRMS’s choice for high-efficacy agents was established as the participant’s selection of monoclonal antibodies for case scenarios with at least 2 years of clinical and radiological stability. Results A total of 211 PwRRMS were studied (mean age 39.1 ± 9.5 years, 70.1% female, mean Expanded Disability Status Scale score 1.8 ± 1.1). Almost 50% (n = 96) opted for a high-efficacy DMT despite the lack of evidence of disease activity. Younger age and risk-seeking behavior were associated with an increased likelihood of selecting unwarranted high-efficacy DMT [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.02–3.93, p = 0.043, and OR 2.17, 95% CI 1.09–4.30, p = 0.027, respectively]. Clinical characteristics or subjective perception of symptom severity had no influence on participants’ treatment choices. Conclusion Identifying PwRRMS with risk-seeking behavior would be crucial to implementing specific educational strategies to manage information on disease prognosis, treatment expectations, and safety risk knowledge.

Suggested Citation

  • Jorge Maurino & Javier Sotoca & Ángel P. Sempere & Luis Brieva & Carlos López de Silanes & Ana B. Caminero & María Terzaghi & Julia Gracia-Gil & Gustavo Saposnik, 2021. "High-Efficacy Disease-Modifying Therapies in People with Relapsing–Remitting Multiple Sclerosis: The Role of Risk Attitude in Treatment Decisions," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 14(2), pages 241-248, March.
    • Handle: RePEc:spr:patien:v:14:y:2021:i:2:d:10.1007_s40271-020-00454-3
    DOI: 10.1007/s40271-020-00454-3
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    References listed on IDEAS

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    1. Julia Krämer & Jan-Gerd Tenberge & Ingo Kleiter & Wolfgang Gaissmaier & Tobias Ruck & Christoph Heesen & Sven G Meuth, 2017. "Is the risk of progressive multifocal leukoencephalopathy the real reason for natalizumab discontinuation in patients with multiple sclerosis?," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-17, April.
    2. Edward J. D. Webb & David Meads & Ieva Eskytė & Helen L. Ford & Hilary L. Bekker & Jeremy Chataway & George Pepper & Joachim Marti & Yasmina Okan & Sue H. Pavitt & Klaus Schmierer & Ana Manzano, 2020. "The Impact of Reproductive Issues on Preferences of Women with Relapsing Multiple Sclerosis for Disease-Modifying Treatments," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 13(5), pages 583-597, October.
    3. Caroline Vass & Dan Rigby & Katherine Payne, 2019. "“I Was Trying to Do the Maths”: Exploring the Impact of Risk Communication in Discrete Choice Experiments," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(1), pages 113-123, February.
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    1. Stolk-Vos, Aline C. & Attema, Arthur E. & Manzulli, Michele & van de Klundert, Joris J., 2022. "Do patients and other stakeholders value health service quality equally? A prospect theory based choice experiment in cataract care," Social Science & Medicine, Elsevier, vol. 294(C).

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