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Treatment selection and experience in multiple sclerosis: survey of neurologists

Authors Hanson K, Agashivala N, Wyrwich KW, Raimundo K, Kim E, Brandes D

Received 17 August 2013

Accepted for publication 7 November 2013

Published 3 April 2014 Volume 2014:8 Pages 415—422

DOI https://doi.org/10.2147/PPA.S53140

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Kristin A Hanson,1 Neetu Agashivala,2 Kathleen W Wyrwich,3 Karina Raimundo,2 Edward Kim,2 David W Brandes4

1UBC: An Express Scripts Company, Dorval, QC, Canada; 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Evidera, Bethesda, MD, USA; 4Hope MS Center, Knoxville, TN, USA

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 ß-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.

Keywords: multiple sclerosis, disease-modifying therapy, physician survey, treatment selection, treatment adherence, treatment satisfaction

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