Novartis Pharma AG, Basel, Switzerland.
Department of Neurosciences, University Hospitals of Coventry and Warwickshire, Level 4, Central Wing, Coventry CV2 2DX, UK.
Mult Scler Relat Disord. 2023 Aug;76:104770. doi: 10.1016/j.msard.2023.104770. Epub 2023 May 26.
The decision of initiating treatment for multiple sclerosis (MS) with a high-efficacy DMT (HE DMT) or non-high-efficacy DMT (non-HE DMT) is influenced by several factors, including risk perception of patients and physicians.
Investigate the influence of physicians' risk perception on decision-making when switching treatments for MS and the reasons for switching.
Data were drawn from the Adelphi Real-World MS Disease-Specific Program (a retrospective survey) and analysis included people with RMS identified between 2017- 2021.
Of 4129 patients with reasons for switch available, 3538 switched from non-HE DMT and 591 from HE DMT. Overall, 4.7% of patients were switched treatment by their physicians due to the risk of malignancies and infections including PML risk. The proportion of switches that were made due to the risk of PML were 23.9% in the HE DMT and 0.5% in the non-HE DMT groups. The top reasons for switching were relapse frequency (non-HE DMT vs HE-DMT: 26.8% vs 15.2%), lack of efficacy (20.9 vs 11.7) and increased number of MRI lesions (20.3% vs 12.4%).
Physicians' risk perception of malignancies and infection excluding PML was not a leading factor when switching treatment. The risk of PML was a key factor, especially for switching patients from HE DMTs. In both groups, lack of efficacy was the key contributing factor for switching. Initiating the treatment with HE DMTs may potentially reduce the number of switches due to sub-optimal efficacy. These findings might help physicians to engage more in discussions with patients about the benefit/risk profile of DMTs.
启动多发性硬化症（MS）治疗时选择高效疾病修正治疗药物（HE DMT）或非高效疾病修正治疗药物（non-HE DMT）的决策受到多种因素的影响，包括患者和医生的风险感知。
调查医生的风险感知对 MS 治疗转换决策的影响，以及转换的原因。
数据来自 Adelphi 真实世界 MS 疾病特异性项目（回顾性调查），分析包括 2017-2021 年期间确诊为 RMS 的患者。
在有转换原因的 4129 名患者中，3538 名患者从非-HE DMT 转换，591 名患者从 HE DMT 转换。总体而言，由于恶性肿瘤和感染（包括 PML 风险）的风险，有 4.7%的患者由医生决定转换治疗。在 HE DMT 组中，因 PML 风险而转换的比例为 23.9%，而非-HE DMT 组为 0.5%。转换的主要原因是复发频率（非-HE DMT 与 HE-DMT：26.8%与 15.2%）、疗效不足（20.9%与 11.7%）和 MRI 病变数量增加（20.3%与 12.4%）。
医生对恶性肿瘤和感染（不包括 PML）的风险感知并不是转换治疗的主要因素。PML 风险是一个关键因素，特别是对于从 HE DMT 转换的患者。在两组中，疗效不足是转换的关键因素。使用 HE DMT 进行初始治疗可能会降低因疗效不佳而导致的转换次数。这些发现可能有助于医生更深入地与患者讨论 DMT 的获益/风险特征。
