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Patients’ Preferences for Sphingosine-1-Phosphate Receptor Modulators in Multiple Sclerosis Based on Clinical Management Considerations: A Choice Experiment

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Abstract

Background

Several sphingosine-1-phosphate receptor (S1PR) modulators are available in the US for treating relapsing forms of multiple sclerosis (RMS). Given that these S1PR modulators have similar efficacy and safety, patients may consider the clinical management characteristics of the S1PR modulators when deciding among treatments. However, none of the S1PR modulators is clearly superior in every aspect of clinical management, and for some treatments, clinical management varies based on a patient’s comorbid health conditions (e.g., heart conditions [HC]).

Objectives

This study aimed to determine which S1PR modulator patients with relapsing-remitting multiple sclerosis (RRMS) would prefer based on clinical management considerations, and to estimate how different clinical management considerations might drive these preferences. Preferences were explored separately for patients with and without comorbid HC.

Methods

A multicriteria decision analysis was conducted on S1PR modulators approved to treat RMS: fingolimod, ozanimod, siponimod, and ponesimod. Clinical management preferences of patients with RRMS were elicited in a discrete choice experiment (DCE) in which participants repeatedly chose between hypothetical S1PR modulator profiles based on their clinical management attributes. Attributes included first-dose observations, genotyping, liver function tests, eye examinations, drug–drug interactions, interactions with antidepressants, interactions with foods high in tyramine, and immune system recovery time. Preferences were estimated separately for patients with HC and without HC (noHC). Marginal utilities were calculated from the DCE data for each attribute and level using a mixed logit model. In the multicriteria decision analysis, partial value scores were created by applying the marginal utilities for each attribute and level to the real-world profiles of S1PR modulators. Partial value scores were summed to determine an overall clinical management value score for each S1PR modulator.

Results

Four hundred patients with RRMS completed the DCE. Ponesimod had the highest overall value score for patients both without (n = 341) and with (n = 59) HC (noHC: 5.1; HC: 4.0), followed by siponimod (noHC: 4.9; HC: 3.3), fingolimod (noHC: 3.4; HC: 2.8), and ozanimod (noHC: 0.9; HC: 0.8). Overall, immune system recovery time contributed the highest partial value scores (noHC: up to 1.9 points; HC: up to 1.2 points), followed by the number of drug–drug interactions (noHC: up to 1.2 points; HC: up to 1.7 points).

Conclusions

When considering the clinical management of S1PR modulators, the average patient with RRMS is expected to choose a treatment with shorter immune system recovery time and fewer interactions with other drugs. Patients both with and without heart conditions are likely to prefer the clinical management profile of ponesimod over those of siponimod, fingolimod, and ozanimod. This information can help inform recommendations for treating RRMS and facilitate shared decision making between patients and their doctors.

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Acknowledgements

Medical writing was provided by Jacqueline Janowich Wasserott, PhD (Evidera), and funded by Janssen.

Author information

Authors and Affiliations

  1. Janssen Scientific Affairs, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA

    Alexander Keenan & Hoa H. Le

  2. Evidera, The Ark, 201 Talgarth Rd, London, W6 8BJ, UK

    Chiara Whichello, Vicky Turner, Anup Das & Matthew Quaife

  3. Janssen Research and Development, 800 Ridgeview Drive, Horsham, PA, 19044, USA

    David M. Kern

  4. Evidera, 7101 Wisconsin Ave # 1400, Bethesda, MD, 20814, USA

    Gabriela S. Fernandez

  5. Loyola University Chicago, 2160 S 1st Ave, Maywood, IL, 60153, USA

    Amy Perrin Ross

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  1. Alexander Keenan
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Corresponding author

Correspondence to Alexander Keenan.

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Funding

This study was funded by Janssen. The sponsor was involved in the study design but had no role in data collection, data analysis, data interpretation, or writing of the statistical report. All authors had full access to the study data and had final responsibility for the decision to submit this article for publication. CW, GSF, VT, AD, and MQ are employees of Evidera, part of the clinical research group within Thermo Fisher Scientific, which received funding from Janssen to conduct this study. AK, HHL, and DMK are employees of Janssen and may own Johnson & Johnson stocks. APR reports having received consulting fees from Janssen. Medical writing was provided by Jacqueline Janowich Wasserott (Evidera) and was funded by Janssen.

Author contributions

AK: Conceptualization, methodology, software, writing—original draft, writing—review and editing, supervision. CW: Conceptualization, methodology, validation, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, visualization, supervision, project administration. HHL: Conceptualization, methodology, writing—original draft, writing—review and editing, supervision. DMK: Conceptualization, methodology, writing—review and editing, supervision. GSF: Conceptualization, methodology, validation, investigation, data curation, writing—original draft, writing—review and editing, project administration. VT: Methodology, validation, investigation, data curation, writing—original draft, writing—review and editing. AD: Methodology, validation, formal analysis, investigation, data curation, writing—review and editing, visualization. MQ: Conceptualization, methodology, validation, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, supervision. APR: Conceptualization, writing—review and editing.

Conflict of Interest

Chiara Whichello, Gabriela S. Fernandez, Vicky Turner, Anup Das, and Matthew Quaife are employees of Evidera, which received funding from Janssen to conduct this study. Alexander Keenan, Hoa H. Le, and David M. Kern are employees of Janssen and may own Johnson & Johnson stocks. Amy Perrin Ross reports having received consulting fees from EMD Serono, BMS, Novartis, Janssen, Genzyme, Horizon, Alexion, TG Therapeutics, Roche, and Merke, as well as payments or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from EMD Serono, BMS, Novartis, Genzyme, Horizon, Alexion, and TG Therapeutics.

Data Availability

The informed consent obtained from participants does not allow for individual data to be made publicly available.

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Keenan, A., Whichello, C., Le, H.H. et al. Patients’ Preferences for Sphingosine-1-Phosphate Receptor Modulators in Multiple Sclerosis Based on Clinical Management Considerations: A Choice Experiment. Patient (2024). https://doi.org/10.1007/s40271-024-00699-2

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