Keenan Alexander, Whichello Chiara, Le Hoa H, Kern David M, Fernandez Gabriela S, Turner Vicky, Das Anup, Quaife Matt, Ross Amy Perrin
Janssen Scientific Affairs, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA.
Evidera, The Ark, 201 Talgarth Rd, London, W6 8BJ, UK.
Pharmacoecon Open. 2024 Nov;8(6):857-867. doi: 10.1007/s41669-024-00510-w. Epub 2024 Aug 28.
Four sphingosine-1-phosphate receptor (S1PR) modulators are currently available in the USA for treating relapsing forms of multiple sclerosis (MS). These S1PR modulators have similar efficacy. Clinicians may therefore consider other factors, such as clinical management considerations, when distinguishing among treatments. This study estimated which S1PR modulator clinicians would choose on the basis of a treatment's clinical management and quantified how individual aspects of clinical management might drive this choice.
A multi-criteria decision analysis (MCDA) was conducted on the basis of clinical management preferences elicited in a discrete choice experiment (DCE) and real-world clinical management profiles of the S1PR modulators currently available to treat relapsing forms of MS (fingolimod, ozanimod, ponesimod, siponimod). The DCE was completed by neurologists in the USA experienced in treating MS and included eight clinical management attributes: first-dose observations, genotyping, liver function tests, eye exams, drug-drug interactions, interactions with antidepressants, interactions with foods high in tyramine, and immune system recovery time. Attribute levels were selected on the basis of S1PR modulator product labels. In the MCDA, partial MCDA scores were created for each attribute and summed to produce an overall MCDA score for each S1PR modulator.
The DCE was completed by 200 neurologists. The overall MCDA score was highest for ponesimod (4.78 points), followed by siponimod (4.10 points), fingolimod (3.61 points), and ozanimod (2.38 points). Having fewer drug-drug interactions contributed most to the overall scores (up to 1.56 points), followed by having no first-dose observations (0.95 points), the shortest immune system recovery time (0.94 points), and not interacting with foods high in tyramine (0.86 points).
When considering clinical management convenience, the average US-based neurologist treating MS is likely to choose ponesimod over siponimod, fingolimod, or ozanimod. The strongest driver of preferences was the number of drug-drug interactions. This information can help inform recommendations for the treatment of MS and facilitate shared decision-making between clinicians and patients.
目前在美国有四种鞘氨醇-1-磷酸受体（S1PR）调节剂可用于治疗复发型多发性硬化症（MS）。这些S1PR调节剂具有相似的疗效。因此，临床医生在区分不同治疗方法时可能会考虑其他因素，如临床管理方面的因素。本研究估计了临床医生会基于治疗的临床管理选择哪种S1PR调节剂，并量化了临床管理的各个方面如何驱动这一选择。
基于离散选择实验（DCE）中得出的临床管理偏好以及目前可用于治疗复发型MS的S1PR调节剂（芬戈莫德、奥扎莫德、波尼松莫德、西普尼莫德）的真实世界临床管理概况，进行了多标准决策分析（MCDA）。DCE由美国有治疗MS经验的神经科医生完成，包括八个临床管理属性：首剂观察、基因分型、肝功能检查、眼科检查、药物相互作用、与抗抑郁药的相互作用、与富含酪胺食物的相互作用以及免疫系统恢复时间。属性水平是根据S1PR调节剂产品标签选择的。在MCDA中，为每个属性创建了部分MCDA分数，并将其相加得出每个S1PR调节剂的总体MCDA分数。
200名神经科医生完成了DCE。总体MCDA分数最高的是波尼松莫德（4.78分），其次是西普尼莫德（4.10分）、芬戈莫德（3.61分）和奥扎莫德（2.38分）。药物相互作用较少对总体分数的贡献最大（高达1.56分），其次是无需首剂观察（0.95分）、免疫系统恢复时间最短（0.94分）以及不与富含酪胺的食物相互作用（0.86分）。
在考虑临床管理便利性时，美国治疗MS的神经科医生平均可能会选择波尼松莫德而非西普尼莫德、芬戈莫德或奥扎莫德。偏好的最主要驱动因素是药物相互作用的数量。这些信息有助于为MS治疗提供建议，并促进临床医生与患者之间的共同决策。
