What’s the Treatment selection

Treatment selection and experience in multiple sclerosis: survey of neurologists.Hanson KA, Agashivala N, Wyrwich KW, Raimundo K, Kim E, Brandes DW. Patient Prefer Adherence. 2014 ;8:415-22.

BACKGROUND:Multiple sclerosis (MS) is a complex disease with many therapeutic options. Little is known about how neurologists select particular disease-modifying therapies (DMTs) for their patients.
OBJECTIVE:To understand how neurologists make decisions regarding the prescription of DMTs for patients with MS, and to explore neurologists’ experiences with individual DMTs.
METHODS:From December 2012 to January 2013, members of a nationwide physician market research panel were sent an online study invitation with a link to a survey website. Eligible neurologists were included if they currently practice medicine in the United States, and if they treat ≥20 patients with MS.
RESULTS:A total of 102 neurologists (n=63 general neurologists; n=39 MS specialists; 81.4% male) completed the survey. The mean (standard deviation) number of years in practice since completing medical training was 16.4 (8.6) years. Overall, the most commonly prescribed DMTs were subcutaneous interferon (IFN) β-1a and glatiramer acetate; approximately 5.5% of patients were untreated. The most important attributes of DMT medication selection were (in order of importance) efficacy, safety, tolerability, patient preference, and convenience. The DMT with the highest neurologist-reported percentage of patients who were “Very/Extremely Satisfied” with their therapy was fingolimod (31.0%), followed by glatiramer acetate (13.9%; P=0.017). Compared with fingolimod (94.0%), significantly fewer (P<0.05) neurologists reported that “All/Most” of their patients were adherent to treatment with glatiramer acetate (78.0%), subcutaneous IFN β-1a (84.0%), and IFN β-1b (75.0%); no significant differences were observed with intramuscular IFN β-1a (92.9%; P=0.75). Patients’ calls to neurologists’ offices were most commonly related to side effects for all self-injectable DMTs, whereas calls about fingolimod primarily involved insurance coverage issues.
CONCLUSION:Our survey results showed that very few patients with MS did not received any DMT. Among the DMTs available at the time of the survey, neurologists reported that patients were most satisfied with, and adherent to, fingolimod, but these patients also faced more problems with insurance coverage when compared with those taking self-injectable DMTs.

One thing that I got from MS life 2014 was the difference between people and their understanding of MS and the different treatments available.

Education Education Education is the name of the game.

This is what will help get rid of the postcode lottery
We need to do more to Educate

Some people just don’t want to know and others are sponges for information. Whilst I think that if you are reading this you are more related to Bob than an Ostrich. If you have your head in the ground then even getting good advice from other MSers is going to be difficult also.

I was particularly very impressed by one our MSer bloggers talking sense.

If you don’t want to know, you are then completely dependent on your neuro guiding you to the right choices. If they are up to speed it is no doubt the right choice, but if they are not up to speed then you can suffer the consequences. It is your future, the more you know the more empowered you are.

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  • Believing that all doctors are gods is not helpful in the context of MS. I knew too many medics at university to go down this road, but it's a common attitude.

  • but what can I do if my neuro seems to be very conservative and the fact that I was not eligible for DMDs (which was wrong, because no I know that I am in eligible) called ''not a bad news''?

  • My neuro suggests me to stop reading too much on interwebz to keep my (and her also) mental health well

  • If 5% of MS pts are untreated then there is vast and completey unnecessary and unethical over treatment. This wouldn't be the corrupt US health service by any chance?



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