Consensus statement on the treatment of multiple sclerosis by the Spanish Society of Neurology in 2016

Merino, A. García; Callizo, José Ramón Ara; Fernández, Óscar; Pascual, Lamberto Landete; Torres, E. Moral; Zarrantz, A. Rodríguez-Antigüedad

doi:10.1016/j.nrleng.2016.02.003

Cited by 16 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Based on our findings, fingolimod was used mainly as a second-line drug in patients diagnosed with RRMS, and only two of the 55 patients in our dataset started treatment with fingolimod immediately after diagnosis. These data are in alignment with the recommendations of the RRMS clinical treatment guidelines, in which fingolimod is recommended as second-line therapy, thus restricting its use as a first-line option in patients presenting with aggressive forms of RRMS 2 14. In a previous study by Ontaneda et al ,15 only 3.5% of patients were treatment-naïve and 41.6% of patients started fingolimod as second-line treatment, compared with 74.6% in our study.…”

Section: Discussionsupporting

confidence: 89%

“…In the case of relapsing-remitting MS (RRMS), outbreaks occur frequently—that is, episodes of neurological dysfunction that last for days or weeks and usually remit partially or totally, especially in the initial stages of the disease. However, approximately 10% of patients experience progressive neurological deterioration without outbreaks, suffering so-called primary progressive MS 2…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fingolimod in multiple sclerosis: profile of use in habitual practice

et al. 2019

View full text Add to dashboard Cite

ObjectivesFingolimod is the first oral drug indicated in monotherapy as a modifier of the course of very active relapsing-remitting multiple sclerosis (RRMS). The safety profile of fingolimod is well established in clinical trials and post-marketing studies. Our objective was to study the profile of fingolimod use in our health area.MethodsA retrospective, observational, descriptive study was performed on the use of fingolimod in adult patients diagnosed with RRMS between January 2015 and February 2017 or until suspension of treatment in a reference hospital in north-western Spain.ResultsA total of 55 patients were included with a mean±SD time of treatment with fingolimod of 26±14.6 months (range 2–53). Thirteen patients permanently discontinued the treatment (10 due to outbreaks/disease progression and 3 due to adverse effects). No statistically significant differences were found between the percentage of patients who discontinued fingolimod and who had received only one previous treatment and those who had received two or more treatments. No cases of symptomatic bradycardia were reported.ConclusionsFingolimod is a safe treatment for patients with multiple sclerosis.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Fingolimod in multiple sclerosis: profile of use in habitual practice

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The country of primary clinical practice was also identified as an independent predictor of TI. The observed differences among countries can be partially explained by variations in adherence to published MS management guidelines, regional differences regarding eligibility and access to DMTs, public funding of DMTs, and physician-related factors, such as risk preferences and education in risk management and decision making.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation is that physicians' decisions to escalate therapy are influenced by factors like availability of the drug, local policies, drug costs, variations in treatment guidelines in different countries, and other unmeasured variables that can alter the assessment of TI. 26,31,32 However, all included countries shared private and government-funded MS drug coverage in the absence of private health insurance. 33,34 A previous study 35 showed a limited role of costs in explaining therapeutic decisions and TI.…”

Section: Limitationsmentioning

confidence: 99%

Comparison of Physician Therapeutic Inertia for Management of Patients With Multiple Sclerosis in Canada, Argentina, Chile, and Spain

Almusalam

Terzaghi

et al. 2019

JAMA Netw Open

View full text Add to dashboard Cite

IMPORTANCE There is growing interest in understanding and addressing factors that govern the decision-making process in multiple sclerosis (MS) care. Therapeutic inertia (TI) is the failure to escalate therapy when goals are unmet. Limited data are available on the prevalence of TI and factors affecting therapeutic decisions in the management of patients with MS worldwide. OBJECTIVES To compare TI across 4 countries (Canada, Argentina, Chile, and Spain) and to identify factors contributing to TI.

show abstract

“…National and regional recommendations include escalating therapy from a first-line agent to a second-line agent when there is evidence of clinical and radiological disease progression. 6 , 11 – 15 However, switching to a second-line agent is not supported by best practice recommendations if an MS patient has been clinically stable, with no new lesions on a follow-up magnetic resonance imaging (MRI) or no progression on the disability scale. 6 , 11 – 15 For the current analysis, we used the aforementioned scheme according to the current clinical practice.…”

Section: Methodsmentioning

confidence: 99%

Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS

Saposnik

Mauriño

Pérez-Sempere

et al. 2017

PPA

View full text Add to dashboard Cite

PurposeHerding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS) when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors) of herding in the management of MS.MethodsWe conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI) lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding.ResultsOut of 161 neurologists who were invited to participate, 96 completed the study (response rate: 60%). Herding was present in 75 (78.1%), having a similar prevalence in MS experts and general neurologists (68.8% vs 82.8%; P=0.12). In multivariate analyses, the number of MS patients seen per week was positively associated with herding (odds ratio [OR] 1.08, 95% CI 1.01–1.14). Conversely, physician’s age, gender, years of practice, setting of practice, or risk preferences were not associated with herding.ConclusionHerding was a common phenomenon affecting nearly 8 out of 10 neurologists caring for MS patients. Herding may affect medical decisions and lead to poorer outcomes in the management of MS.

show abstract

Consensus statement on the treatment of multiple sclerosis by the Spanish Society of Neurology in 2016

Cited by 16 publications

References 39 publications

Fingolimod in multiple sclerosis: profile of use in habitual practice

Fingolimod in multiple sclerosis: profile of use in habitual practice

Comparison of Physician Therapeutic Inertia for Management of Patients With Multiple Sclerosis in Canada, Argentina, Chile, and Spain

Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS

Contact Info

Product

Resources

About