Saposnik Gustavo, Sotoca Javier, Sempere Ángel P, Candeliere-Merlicco Antonio, Díaz-Abós Paola, Tobler Philippe N, Terzaghi María, Maurino Jorge
Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Switzerland; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada.
Department of Neurology, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
Mult Scler Relat Disord. 2020 Oct;45:102354. doi: 10.1016/j.msard.2020.102354. Epub 2020 Jul 2.
Status quo (SQ) bias is defined as patient´s tendency to continue taking a previously selected but inferior therapeutic option.
To assess the presence of SQ bias and its associated factors in patients with relapsing-remitting multiple sclerosis (RRMS).
A multicenter, non-interventional study involving 211 patients with RRMS was conducted. Participants answered questions regarding risk preferences and management of simulated MS case-scenarios. The SymptoMScreen (SMSS) questionnaire was used to assess the perception of severity from the patients´ perspective. SQ bias was defined as patients' preference to maintain the current treatment despite evidence of disease activity. Mixed linear models adjusting for clustering assessed the association of candidate predictors with the outcome of interest.
The mean age (SD) was 39.1 (9.5) years and 70.6% were women. SQ bias was observed in 74.4% (n=161) participants. Univariate analysis showed that SMSS score was associated with SQ bias (OR 1.04; 95% CI 1.01-1.07). Mixed linear regression models suggest that for every point increase in SMSS, there was a 4% increase in the likelihood of SQ bias (β 0.04; 95%CI 0.015-0.06; p<0.002). Among the different symptomatic dimensions included in the SMSS, only vision impairment (β 0.32; 95%CI 0.05-0.50) and depression (β 0.29; 95%CI 0.006-0.58) remained associated with SQ bias in the multivariate analysis. There was no association between participants' risk preferences and SQ bias.
Unwillingness to pursue treatments that are more effective is a common phenomenon affecting over 7 out of 10 patients with RRMS. This phenomenon appears to be driven by patients' negative self-perception of their clinical status.
现状偏差被定义为患者倾向于继续采用先前选择但效果较差的治疗方案。
评估复发缓解型多发性硬化症（RRMS）患者中现状偏差的存在情况及其相关因素。
开展了一项涉及211例RRMS患者的多中心非干预性研究。参与者回答了有关风险偏好和模拟MS病例情景管理的问题。SymptoMScreen（SMSS）问卷用于从患者角度评估严重程度感知。现状偏差被定义为尽管有疾病活动证据，患者仍倾向于维持当前治疗。调整聚类的混合线性模型评估了候选预测因素与感兴趣结局之间的关联。
平均年龄（标准差）为39.1（9.5）岁，70.6%为女性。74.4%（n = 161）的参与者存在现状偏差。单因素分析显示，SMSS评分与现状偏差相关（比值比1.04；95%置信区间1.01 - 1.07）。混合线性回归模型表明，SMSS每增加1分，现状偏差的可能性增加4%（β 0.04；95%置信区间0.015 - 0.06；p < 0.002）。在SMSS包含的不同症状维度中，多因素分析中仅视力损害（β 0.32；95%置信区间0.05 - 0.50）和抑郁（β 0.29；95%置信区间0.006 - 0.58）与现状偏差相关。参与者的风险偏好与现状偏差之间无关联。
不愿采用更有效的治疗方法是一种常见现象，影响超过十分之七的RRMS患者。这种现象似乎是由患者对自身临床状况的负面自我认知驱动的。
