Mansfield Carol, Thomas Nina, Gebben David, Lucas Maria, Hauber A Brett
Int J MS Care. 2017 Jul-Aug;19(4):172-183. doi: 10.7224/1537-2073.2016-039.
The growing number of treatments for relapsing multiple sclerosis (MS) provides opportunities to consider patient preferences in treatment decisions.
We designed a Web-based, discrete-choice experiment survey to analyze treatment preferences in patients with relapsing-remitting MS (RRMS). The survey presented hypothetical MS treatments defined by six attributes: risk of MS progression, time between relapses, risk of serious infection, treatment-related flu-like symptoms and gastrointestinal symptoms, and route and frequency of administration. Preference weights estimated with random-parameters logit were used to calculate importance scores and preference shares among three pairs of subsamples.
Patients with a self-reported physician diagnosis of RRMS (N = 301) completed the survey: 56% rated their disability level as normal or mild; 43% currently used a self-injectable treatment. Respondents with normal or mild disability levels placed greater weight on avoiding injections with flu-like symptoms and risk of progression, whereas patients with worse disability placed greater weight on reducing risk of progression and risk of serious infection. Patients taking injectables placed the most weight on risk of progression and risk of serious infection, whereas respondents not taking injectables placed the most weight on route and frequency of administration. Differences in preferences between subgroups were significant (P < .05). The presence of common adverse events associated with daily pills and injectables altered predicted preferences for route of administration.
Preferences of patients with RRMS varied depending on current treatment and disability level, especially regarding mode of administration. Considering patient preferences for treatment features may lead to higher treatment satisfaction and adherence.
复发型多发性硬化症（MS）的治疗方法日益增多，这为在治疗决策中考虑患者偏好提供了机会。
我们设计了一项基于网络的离散选择实验调查，以分析复发缓解型MS（RRMS）患者的治疗偏好。该调查展示了由六个属性定义的假设性MS治疗方法：MS进展风险、复发间隔时间、严重感染风险、与治疗相关的流感样症状和胃肠道症状，以及给药途径和频率。使用随机参数logit估计的偏好权重来计算三个子样本对之间的重要性得分和偏好份额。
自我报告经医生诊断为RRMS的患者（N = 301）完成了调查：56%将其残疾水平评为正常或轻度；43%目前使用自我注射治疗。残疾水平正常或轻度的受访者更重视避免出现伴有流感样症状的注射以及进展风险，而残疾程度更严重的患者更重视降低进展风险和严重感染风险。正在接受注射治疗的患者最重视进展风险和严重感染风险，而未接受注射治疗的受访者最重视给药途径和频率。亚组之间的偏好差异具有统计学意义（P < .05）。与每日服用的药丸和注射剂相关的常见不良事件的存在改变了对给药途径的预测偏好。
RRMS患者的偏好因当前治疗和残疾水平而异，尤其是在给药方式方面。考虑患者对治疗特征的偏好可能会提高治疗满意度和依从性。
