Survey of diagnostic and treatment practices for multiple sclerosis in Europe

Fernández, Óscar; Delvecchio, Maurizio; Edan, Gilles; Fredrikson, Sten; Gionvannoni, G.; Hartung, Hans Peter; Havrdová, Eva; Kappos, Ludwig; Pozzilli, Carlo; Soerensen, Per Soelberg; Tackenberg, Björn; Vermersch, Patrick; Comı, Gıancarlo

doi:10.1111/ene.13236

Cited by 38 publications

(28 citation statements)

References 8 publications

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“…In conclusion, the results of part 2 of the survey of diagnostic and treatment practices for MS in Europe largely mirror the results of part 1 . Areas of general agreement amongst neurologists include the treatment and management of SPMS, PPMS, pregnancy and paediatric MS as well as the general management of MS.…”

Section: Discussionmentioning

confidence: 61%

“…Respondent demographics were summarized in detail previously . Surveys were distributed to 350 MS neurologists; 216 respondents completed Survey 1 and 171 respondents completed Survey 2.…”

Section: Resultsmentioning

confidence: 99%

“…Full details of the methodology have been provided previously . Surveys were developed using a modified Delphi method .…”

Section: Methodsmentioning

confidence: 99%

“…In order to understand current diagnostic and practice patterns and the extent to which new concepts are being incorporated into clinical practice, the European Charcot Foundation assembled a group of neurologists to develop sequential surveys with case‐based questions covering radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing−remitting MS (RRMS), progressive MS, pregnancy with MS, paediatric MS and general patient management. The results of surveys related to RIS, CIS and RRMS were published recently . This report presents additional results of the survey related to progressive MS, pregnancy with MS, paediatric MS and overall patient management.…”

Section: Introductionmentioning

confidence: 93%

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Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management

Fernández

Delvecchio

Edan

et al. 2018

Euro J of Neurology

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Results of part 2 of the survey of diagnostic and treatment practices for MS in Europe largely mirror results for part 1, with neurologists in general agreement about the treatment and management of SPMS, PPMS, pregnancy and paediatric MS as well as the general management of MS. However, there are also many areas of disagreement, indicating the need for evidence-based recommendations and/or guidelines.

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Section: Discussionmentioning

confidence: 61%

“…Respondent demographics were summarized in detail previously . Surveys were distributed to 350 MS neurologists; 216 respondents completed Survey 1 and 171 respondents completed Survey 2.…”

Section: Resultsmentioning

confidence: 99%

“…Full details of the methodology have been provided previously . Surveys were developed using a modified Delphi method .…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

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Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management

Fernández

Delvecchio

Edan

et al. 2018

Euro J of Neurology

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“…The management and outcome of multiple sclerosis has been transformed by the use of immunomodulation therapies . Outcome measures, as judged by patient‐reported outcomes, remain an important area for development and are relevant for care delivery design .…”

mentioning

confidence: 99%

Progress in neurology 2017–2018

Schapira

2018

Euro J of Neurology

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Treatment Escalation vs Immediate Initiation of Highly Effective Treatment for Patients With Relapsing-Remitting Multiple Sclerosis

et al. 2021

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IMPORTANCETreatment strategies for relapsing-remitting multiple sclerosis (RRMS) vary markedly between Denmark and Sweden. The difference in the association of these national strategies with clinical outcomes is unknown.OBJECTIVE To investigate the association of national differences in disease-modifying treatment (DMT) strategies for RRMS with disability outcomes. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used data on 4861 patients from the Danish and Swedish national multiple sclerosis (MS) registries from the date of index DMT initiation (between January 1, 2013, and December 31, 2016) until the last recorded visit at time of data extraction (October 2, 2019).EXPOSURES All MS-specific DMTs initiated during the observation period were included in the analysis. MAIN OUTCOMES AND MEASURESThe primary study outcome was time to 24-week confirmed disability worsening. Secondary outcomes were 24-week confirmed disability improvement, milestone Expanded Disability Status Scale scores of 3 and 4, annualized relapse rate, time to first relapse, and treatment switching. Data were analyzed using inverse probability of treatment weighting-based models using a propensity score to weight and correct the comparison for the imbalance of confounders observed at baseline between the 2 countries.RESULTS A total of 2700 patients from the Swedish MS registry (1867 women [69.2%]; mean [SD] age, 36.1 [9.5] years) and 2161 patients from the Danish MS registry (1472 women [68.1%]; mean [SD] age, 37.3 [9.4 years]) started a first DMT between 2013 and 2016, were included in the analysis, and were observed for a mean (SD) of 4.1 (1.5) years. A total of 1994 Danish patients (92.3%) initiated a low to moderately effective DMT (teriflunomide, 907 [42.0%]) and 165 (7.6%) initiated a highly effective DMT, whereas a total of 1769 Swedish patients (65.5%) initiated a low to moderately effective DMT (teriflunomide, 64 [2.4%]) and 931 (34.5%) initiated a highly effective DMT. The Swedish treatment strategy was associated with a 29% reduction in the rate of postbaseline 24-week confirmed disability worsening relative to the Danish treatment strategy (hazard ratio, 0.71; 95% CI, 0.57-0.90; P = .004). The Swedish treatment strategy was also associated with a 24% reduction in the rate of reaching an expanded disability status scale score of 3 (hazard ratio, 0.76; 95% CI, 0.60-0.97; P = .03) and a 25% reduction in the rate of reaching an expanded disability status scale score of 4 (hazard ratio, 0.75; 95% CI, 0.61-0.96; P = .01) relative to Danish patients. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that there is an association between differences in treatment strategies for RRMS and disability outcomes at a national level. Escalation of treatment efficacy was inferior to using more efficacious DMT as initial treatment.

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Survey of diagnostic and treatment practices for multiple sclerosis in Europe

Cited by 38 publications

References 8 publications

Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management

Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management

Progress in neurology 2017–2018

Treatment Escalation vs Immediate Initiation of Highly Effective Treatment for Patients With Relapsing-Remitting Multiple Sclerosis

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