Saposnik Gustavo, Andhavarapu Sanketh, Sainz de la Maza Susana, Castillo-Triviño Tamara, Borges Mónica, Barón Beatriz Pardiñas, Sotoca Javier, Alonso Ana, Caminero Ana B, Borrega Laura, Sánchez-Menoyo José L, Barrero-Hernández Francisco J, Calles Carmen, Brieva Luis, Blasco María R, García-Soto Julio Dotor, Del Campo-Amigo María, Navarro-Cantó Laura, Agüera Eduardo, Garcés Moisés, Carmona Olga, Gabaldón-Torres Laura, Forero Lucía, Hervás Mariona, García-Arcelay Elena, Terzaghi María, Gómez-Ballesteros Rocío, Maurino Jorge
Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Canada; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario M5C 1R6, Canada.
Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Canada.
Mult Scler Relat Disord. 2022 Dec;68:104138. doi: 10.1016/j.msard.2022.104138. Epub 2022 Aug 20.
The evolving therapeutic landscape requires more participation of patients with relapsing remitting multiple sclerosis (RRMS) in treatment decisions. The aim of this study was to assess the association between patient's self-perception, cognitive impairment and behavioral factors in treatment choices in a cohort of patients at an early stage of RRMS.
We conducted a multicenter, non-interventional study including adult patients with a diagnosis of RRMS, a disease duration ≤18 months and receiving care at one of the 21 participating MS centers from across Spain. We used patient-reported measures to gather information on fatigue, mood, quality of life, and perception of severity of their MS. Functional metrics (Expanded Disability Status Scale [EDSS], cognitive function by the Symbol Digit Modalities Test [SDMT], 25-foot walk test) and clinical and radiological data were provided by the treating neurologist. The primary outcome of the study was status quo (SQ) bias, defined as participant's tendency to continue taking a previously selected but inferior treatment when intensification was warranted. SQ bias was assessed based on participants treatment preference in six simulated RRMS case scenarios with evidence of clinical relapses and radiological disease progression.
Of 189 participants who met the inclusion criteria, 188 (99.5%) fully completed the study. The mean age was 36.6 ± 9.5 years, 70.7% female, mean disease duration: 1.2 ± 0.8 years, median EDSS score: 1.0 [IQR=0.0-2.0]). Overall, 43.1% patients (n = 81/188) had an abnormal SDMT (≤49 correct answers). SQ bias was observed in at least one case scenario in 72.3% (137/188). Participant's perception of their MS severity was associated with higher SQ bias (β coeff 0.042; 95% CI 0.0074-0.076) among those with delayed cognitive processing. Higher baseline EDSS and number of T2 lesions were predictors of delayed processing speed (OR EDSS=1.57, 95% CI: 1.11-2.21, p = 0.011; OR T2 lesions=1.50, 95% CI: 1.11-2.03, p<0.01). Bayesian multilevel model accounting for clustering showed that delayed cognitive processing (exp coeff 1.06; 95% CI 1.04-1.09) and MS symptoms severity (exp coeff 1.28; 95% CI 1.22-1.33) were associated with SQ bias.
Over 40% of patients in earlier stages of RRMS experience delays in cognitive processing that might affect their decision-making ability. Our findings suggest that patients' self-perception of disease severity combined with a delay in cognitive processing would affect treatment choices leading to status quo bias early in the course of their disease.
不断演变的治疗格局要求复发缓解型多发性硬化症（RRMS）患者更多地参与治疗决策。本研究的目的是评估RRMS早期患者队列中患者的自我认知、认知障碍和行为因素与治疗选择之间的关联。
我们开展了一项多中心、非干预性研究，纳入诊断为RRMS、病程≤18个月且在西班牙21个参与研究的MS中心之一接受治疗的成年患者。我们使用患者报告的指标收集有关疲劳、情绪、生活质量以及对其MS严重程度的认知的信息。功能指标（扩展残疾状态量表[EDSS]、符号数字模态测试[SDMT]评估的认知功能、25英尺步行测试）以及临床和放射学数据由主治神经科医生提供。该研究的主要结局是现状（SQ）偏差，定义为在有必要强化治疗时，参与者倾向于继续服用先前选择但效果较差的治疗方法。基于参与者在六个模拟RRMS病例场景中的治疗偏好评估SQ偏差，这些场景有临床复发和放射学疾病进展的证据。
在189名符合纳入标准的参与者中，188名（99.5%）完全完成了研究。平均年龄为36.6±9.5岁，女性占70.7%，平均病程：1.2±0.8年，EDSS评分中位数：1.0[四分位间距=0.0-2.0]）。总体而言，43.1%的患者（n=81/188）SDMT异常（正确答案≤49个）。72.3%（137/188）的参与者在至少一个病例场景中观察到SQ偏差。在认知处理延迟的参与者中，其对MS严重程度的认知与更高的SQ偏差相关（β系数0.042；95%置信区间0.0074-0.076）。更高的基线EDSS和T2病变数量是处理速度延迟的预测因素（EDSS的比值比=1.57，95%置信区间：1.11-2.21，p=0.011；T2病变的比值比=1.50，95%置信区间：1.11-2.03，p<0.01）。考虑聚类的贝叶斯多层次模型显示，认知处理延迟（指数系数1.06；95%置信区间1.04-1.09）和MS症状严重程度（指数系数1.28；95%置信区间1.22-1.33）与SQ偏差相关。
超过40%的RRMS早期患者存在认知处理延迟，这可能会影响他们的决策能力。我们的研究结果表明，患者对疾病严重程度的自我认知与认知处理延迟相结合，会影响治疗选择，在疾病早期导致现状偏差。
