Clinical decision-making in multiple sclerosis: Challenges reported internationally with emerging treatment complexity

Ng, Pamela; Murray, Suzanne; Hayes, Sean M.

doi:10.1016/j.msard.2015.05.008

Cited by 15 publications

(11 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2,4,5 However, the risk-benefit assessment of treatments as well as the overall therapeutic decisions are gaining in complexity. 6,7 The way the disease is diagnosed and managed is frequently adapted to the most recent evidence to provide optimal treatment and care. 1 An expert panel recently identified a timely diagnosis and treatment initiation as the most influential factors for disease control and an increased likelihood of a milder disease course.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Kaufmann

Kuhle

Puhan

et al. 2018

Multiple Sclerosis Journal - Experimental, Translational and Cl

View full text Add to dashboard Cite

BackgroundRecent studies emphasise the importance of timely diagnosis and early initiation of disease-modifying treatment in the long-term prognosis of multiple sclerosis.ObjectivesThe objective of this study was to investigate factors associated with extended time to diagnosis and time to disease-modifying treatment initiation in the Swiss Multiple Sclerosis Registry.MethodsWe used retrospective data (diagnoses 1996–2017) of the survey-based Swiss Multiple Sclerosis Registry and fitted logistic regression models (extended time to diagnosis ≥2 years from first symptoms, extended time to disease-modifying treatment initiation ≥1 year from diagnosis) with demographic and a priori defined variables.ResultsOur study, based on 996 persons with multiple sclerosis, suggests that 40% had an extended time to diagnosis, and extended time to disease-modifying treatment initiation was seen in 23%. Factors associated with extended time to diagnosis were primary progressive multiple sclerosis (odds ratio (OR) 5.09 (3.12–8.49)), diagnosis setting outside of hospital (neurologist (private practice) OR 1.54 (1.16–2.05)) and more uncommon first symptoms (per additional symptom OR 1.17 (1.06–1.30)). Older age at onset (per additional 5 years OR 0.84 (0.78–0.90)) and gait problems (OR 0.65 (0.47–0.89)) or paresthesia (OR 0.72 (0.54–0.95)) as first symptoms were associated with shorter time to diagnosis. Extended time to disease-modifying treatment initiation was associated with older age at diagnosis (per additional 5 years OR 1.18 (1.09–1.29)). In more recent years, time to diagnosis and time to disease-modifying treatment initiation tended to be shorter.ConclusionsEven in recent periods, substantial and partially systematic variation regarding time to diagnosis and time to disease-modifying treatment initiation remains. With the emerging paradigm of early treatment, the residual variation should be monitored carefully.

show abstract

Section: Introductionmentioning

confidence: 99%

Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Kaufmann

Kuhle

Puhan

et al. 2018

Multiple Sclerosis Journal - Experimental, Translational and Cl

View full text Add to dashboard Cite

show abstract

“…Treatment decisions in MS are becoming difficult after the introduction of several new DMTs with more complicated spectrums of risks and benefits 18. Involving patients with MS in the decision-making process is key to selecting the treatment that best suits the patient's profile and preferences.…”

Section: Discussionmentioning

confidence: 99%

Conjoint analysis to understand preferences of patients with multiple sclerosis for disease-modifying therapy attributes in Spain: a cross-sectional observational study

et al. 2017

View full text Add to dashboard Cite

ObjectiveTo assess patients’ preferences for a range of disease-modifying therapy (DMT) attributes in multiple sclerosis (MS).DesignA cross-sectional observational study.SettingThe data reported were from 17 MS units throughout Spain.ParticipantsAdult patients with relapsing-remitting MS.Main outcomeA conjoint analysis was applied to assess preferences. A total of 221 patients completed a survey with 10 hypothetical DMT profiles developed using an orthogonal design and rating preferences from 1 (most acceptable) to 10 (least acceptable). Medication attributes included preventing relapse, preventing disease progression, side effect risk, route and frequency of administration.ResultsPatients placed the greatest relative importance on the side effect risk domain (32.9%), followed by route of administration (26.1%), frequency of administration (22.7%), prevention of disease progression (10.0%) and prevention of relapse (8.3%). These results were independent of the Expanded Disability Status Scale score. The importance assigned to side effect risk was highest for patients with a recent diagnosis. Patients who had previously received more than one DMT gave a higher importance to relapse rate reduction than patients receiving their first DMT.ConclusionsPatient DMT preferences were mainly driven by risk minimisation, route of administration and treatment schedule. The risk–benefit spectrum of available DMT for MS is becoming increasingly complicated. Understanding which treatment characteristics are meaningful to patients may help to tailor information for them and facilitate shared decision-making in clinical practice.

show abstract

“…2 This adds to the challenge already described by providers where advanced MS treatments are available: it is difficult to remain current on important domains related to DMT prescription, including selecting the correct DMT for a specific patient's characteristics, safety data, and monitoring guidelines, resulting in a call for targeted continuing medical education. 3 Taken together, it is in the interest of the international MS community to have providers with more experience using these DMTs spread the knowledge they have gleaned to providers in countries where these same treatments are emerging. Our videoconference-based education and case consultation program can efficiently meet this need.…”

Section: Accelerating International Ms Care Through Videoconference-bmentioning

confidence: 99%

Accelerating international MS care through videoconference-based education and case consultation

et al. 2016

View full text Add to dashboard Cite

Clinical decision-making in multiple sclerosis: Challenges reported internationally with emerging treatment complexity

Cited by 15 publications

References 12 publications

Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Factors associated with time from first-symptoms to diagnosis and treatment initiation of Multiple Sclerosis in Switzerland

Conjoint analysis to understand preferences of patients with multiple sclerosis for disease-modifying therapy attributes in Spain: a cross-sectional observational study

Accelerating international MS care through videoconference-based education and case consultation

Contact Info

Product

Resources

About