Documento del Grupo de Consenso de la Sociedad Española de Neurología sobre el uso de medicamentos en esclerosis múltiple

García‐Merino, Antonio; Fernández, Óscar; Montalbán, Xavier; Andrés, Clara de; Oreja‐Guevara, Celia; Antigüedad, Alfredo Rodríguez; Arbizu, T.

doi:10.1016/j.nrl.2013.01.009

Cited by 16 publications

(3 citation statements)

References 24 publications

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“…The current treatment option for RRMS include first-line (beta interferons, glatiramer acetate), second-line (fingolimod), and third-line (natalizumab, alemtuzumab) therapies. For the present analysis, we used the aforementioned scheme according to the current clinical practice ( 4 , 34 , 35 ).…”

Section: Methodsmentioning

confidence: 99%

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

et al. 2017

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BackgroundPhysicians often do not initiate or intensify treatments when clearly warranted, a phenomenon known as therapeutic inertia (TI). Limited information is available on educational interventions to ameliorate knowledge-to-action gaps in TI.ObjectivesTo evaluate the feasibility and efficacy of an educational intervention compared to usual care among practicing neurologists caring for patients with multiple sclerosis (MS).MethodsWe conducted a pilot double-blind, parallel-group, randomized clinical trial. Inclusion criteria included neurologists who are actively involved in managing MS patients. Participants were exposed to 20 simulated case-scenarios (10 cases at baseline, and 10 cases post-randomization to usual care vs. educational intervention) of relapsing–remitting MS with moderate or high risk of disease progression. The educational intervention employed a traffic light system (TLS) to facilitate decisions, allowing participants to easily recognize high-risk scenarios requiring treatment escalation. We also measured differences between blocks to invoke decision fatigue. The control group responded as they would do in their usual clinical practice not exposed to the educational intervention. The primary feasibility outcome was the proportion of participants who completed the study and the proportion of participants who correctly identified a high-risk case-scenario with the “red traffic light.” Secondary outcomes included decision fatigue (defined as an increment of TI in the second block of case-scenarios compared to the first block) and the efficacy of the educational intervention measured as a reduction in TI for MS treatment.ResultsOf 30 neurologists invited to be part of the study, the participation rate was 83.3% (n = 25). Of the 25 participants, 14 were randomly assigned to the control group and 11 to the intervention group. TI was present in 72.0% of participants in at least one case scenario. For the primary feasibility outcome, the completion rate of the study was 100% (25/25 participants). Overall, 77.4% of participants correctly identified the “red traffic light” for clinical-scenarios with high risk of disease progression. Similarly, 86.4% of participants correctly identified the “yellow traffic light” for cases that would require a reassessment within 6–12 months. For the secondary fatigue outcome, within-group analysis showed a significant increased prevalence of TI in the second block of case-scenarios (decision fatigue) among participants randomized to the control group (TI pre-intervention 57.1% vs. TI post-intervention 71.4%; p = 0.015), but not in the active group (TI pre-intervention 54.6% vs. TI post-intervention 63.6%; p = 0.14). For the efficacy outcome, we found a non-significant reduction in TI for the targeted intervention compared to controls (22.6 vs. 33.9% post-intervention; OR 0.57; 95% CI 0.26–1.22).ConclusionAn educational intervention applying the TLS is feasible and shows some promising results in the identification of high-risk scenarios to reduce decision fatigue and...

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Section: Methodsmentioning

confidence: 99%

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

et al. 2017

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“…This rationale is based on what has been learned over the years from observational studies, controlled clinical trials, pathophysiological concepts and, more recently, real-world registries. In this context, treatment algorithms from many countries 11,20,21,22,23,24,25,26,27,28,29,30,31 have been guided by what have turned out to be very important concepts: 1) early and effective treatment; 2) the existence of a therapeutic window of opportunity; 3) early optimization of treatment during the therapeutic window; 4) the existence of different clinical and radiological phenotypes; and 5) treatment decisions based on different levels of inflammatory activity and/or specific clinical phenotypes, wherever possible, always favoring the best efficacy/risk ratio.…”

Section: Treatment-related Conceptsmentioning

confidence: 99%

Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis

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et al. 2018

Arq. Neuro-Psiquiatr.

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The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.

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“…Este era también de los denominados de primera línea, ya que nuestro arsenal no contempla hasta ahora la posibilidad de uso de medicamentos de segunda línea de tratamiento [32][33][34][35] .…”

Section: Resultsunclassified

Esclerosis múltiple recurrente remitente en el sector público de salud de Chile: Descripción clínica de 314 pacientes

et al. 2014

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Documento del Grupo de Consenso de la Sociedad Española de Neurología sobre el uso de medicamentos en esclerosis múltiple

Cited by 16 publications

References 24 publications

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis

Esclerosis múltiple recurrente remitente en el sector público de salud de Chile: Descripción clínica de 314 pacientes

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