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High-Efficacy Disease-Modifying Therapies in People with Relapsing–Remitting Multiple Sclerosis: The Role of Risk Attitude in Treatment Decisions

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Abstract

Background

Risk attitude is defined as the willingness to tolerate risk to achieve a greater expected return. Limited information is available on how relapsing–remitting multiple sclerosis people’s perceptions about disease trajectory and risk attitude may influence treatment choices.

Methods

A non-interventional study applying principles of behavioral economics was conducted to assess willingness to receive unwarranted high-efficacy disease-modifying therapy (DMT) according to best-practice guidelines. People with relapsing–remitting multiple sclerosis (PwRRMS) according to 2010 McDonald criteria completed a survey on symptom severity, risk preferences, and management of simulated case scenarios mimicking the current treatment landscape. PwRRMS’s choice for high-efficacy agents was established as the participant’s selection of monoclonal antibodies for case scenarios with at least 2 years of clinical and radiological stability.

Results

A total of 211 PwRRMS were studied (mean age 39.1 ± 9.5 years, 70.1% female, mean Expanded Disability Status Scale score 1.8 ± 1.1). Almost 50% (n = 96) opted for a high-efficacy DMT despite the lack of evidence of disease activity. Younger age and risk-seeking behavior were associated with an increased likelihood of selecting unwarranted high-efficacy DMT [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.02–3.93, p = 0.043, and OR 2.17, 95% CI 1.09–4.30, p = 0.027, respectively]. Clinical characteristics or subjective perception of symptom severity had no influence on participants’ treatment choices.

Conclusion

Identifying PwRRMS with risk-seeking behavior would be crucial to implementing specific educational strategies to manage information on disease prognosis, treatment expectations, and safety risk knowledge.

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Acknowledgements

The abstract of this paper was presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) as a poster presentation with interim findings (P1433; Stockholm, Sweden, September 2019). The authors thank the patients and their families for making the PERCEPTIONS-MS study possible. We also thank Dr. Elena Hernández Martínez-Lapiscina (Hospital Universitari Clínic i Provincial de Barcelona) for her support and contribution to the design of the case scenarios. The PERCEPTIONS-MS Study Group: Eduardo Agüera (Hospital Universitario Reina Sofía, Córdoba), Yolanda Aladro Benito (Hospital Universitario de Getafe, Madrid), José Ramón Ara Callizo (Hospital Universitario Miguel Servet, Zaragoza), Laura Borrego Canelo (Fundación Hospital Alcorcón, Madrid), Luis Brieva (Hospital Universitari Arnau de Vilanova, Lleida), Ana B. Caminero (Complejo Asistencial de Ávila), Antonio Candeliere-Merlicco (Hospital Rafael Méndez, Lorca), Olga Carmona (Hospital de Figueres), Lucía Forero (Hospital Universitario Puerta del Mar, Cádiz), Inmaculada García Castañón (Hospital Universitario de Fuenlabrada, Madrid), Julia Gracia Gil (Complejo Hospitalario Universitario de Albacete), Elena Hernández Martínez Lapiscina (Hospital Clínic i Provincial, Barcelona), Miguel Llaneza (Hospital Arquitecto Marcide, Ferrol), Carlos López de Silanes (Hospital de Torrejón, Torrejón de Ardoz, Madrid), Amelia Mendoza Rodríguez (Complejo Asistencial de Segovia), Luis Querol (Hospital de la Santa Creu i Sant Pau, Barcelona), and Javier Sotoca (Hospital Universitari Mútua Terrassa).

Author information

Authors and Affiliations

  1. Medical Department, Roche Farma, Ribera del Loira, 50, 28042, Madrid, Spain

    Jorge Maurino

  2. Department of Neurology, Hospital Universitari Mútua de Terrassa, Terrassa, Spain

    Javier Sotoca

  3. Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain

    Ángel P. Sempere

  4. Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain

    Luis Brieva

  5. Department of Neurology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain

    Carlos López de Silanes

  6. Department of Neurology, Complejo Asistencial de Ávila, Ávila, Spain

    Ana B. Caminero

  7. Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Toronto, Canada

    María Terzaghi & Gustavo Saposnik

  8. Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain

    Julia Gracia-Gil

  9. Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Gustavo Saposnik

  10. Laboratory for Social and Neural System Research, Department of Economics, University of Zurich, Zurich, Switzerland

    Gustavo Saposnik

Authors
  1. Jorge Maurino
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  7. María Terzaghi
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  8. Julia Gracia-Gil
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  9. Gustavo Saposnik
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Corresponding author

Correspondence to Jorge Maurino.

Ethics declarations

Funding

This study was funded by the Medical Department of Roche Farma Spain (ML40361). The funding source had no role in the design, analysis, and interpretation of the data, review or approval of the manuscript, and decision to submit for publication. Ocrelizumab (manufactured by Roche Farma) was not included as a therapeutic option for any of the simulated case scenarios.

Conflict of Interest

JM is an employee of Roche Farma Spain. GS reports receiving grants and personal fees from Roche Canada and Spain and being supported by the Heart and Stroke Foundation of Canada Scientist Award. JS, APS, LB, CLS, ABC, MT, and JGG declare they have no conflict of interest.

Ethical Approval

This study was approved by the institutional review board of the Hospital Universitari Clínic i Provincial de Barcelona (code ML40361).

Consent to Participate

Written informed consent to participate in the study was obtained from all subjects.

Consent for Publication

Not applicable.

Code availability

Not applicable.

Availability of data and material

Qualified researchers may request access to individual patient-level data through the clinical study data request platform (http://www.clinicalstudydatarequest.com). Further details on Roche’s criteria for eligible studies are available at https://clinicalstudydatarequest.com/Study-Sponsors/Study-Sponsors-Roche.aspx. For further details on Roche’s Global Policy on the Sharing of Clinical Information and how to request access to related clinical study documents, see https://www.roche.com/research_and_development/who_we_are_how_we_work/clinical_trials/our_commitment_to_data_-sharing.htm.

Author Contributions

JM: concept and design, interpretation of data, and drafting the manuscript and revising it for intellectual content. JS: data acquisition, interpretation of data, and revising manuscript for intellectual content. APS: design of the case scenarios, interpretation of data, and revising manuscript for intellectual content. LB, CLS, ABC, and JGG: data acquisition, interpretation of data, and revising manuscript for intellectual content. MT: interpretation of data and revising manuscript for intellectual content. GS: concept and design, statistical analysis, interpretation of data, and drafting the manuscript and revising it for intellectual content.

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Maurino, J., Sotoca, J., Sempere, Á.P. et al. High-Efficacy Disease-Modifying Therapies in People with Relapsing–Remitting Multiple Sclerosis: The Role of Risk Attitude in Treatment Decisions. Patient 14, 241–248 (2021). https://doi.org/10.1007/s40271-020-00454-3

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  • DOI: https://doi.org/10.1007/s40271-020-00454-3

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