High-Efficacy Disease-Modifying Therapies in People with Relapsing–Remitting Multiple Sclerosis: The Role of Risk Attitude in Treatment Decisions

Jorge Maurino (), Javier Sotoca, Ángel P. Sempere, Luis Brieva, Carlos López de Silanes, Ana B. Caminero, María Terzaghi, Julia Gracia-Gil and Gustavo Saposnik
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Jorge Maurino: Roche Farma
Javier Sotoca: Hospital Universitari Mútua de Terrassa
Ángel P. Sempere: Hospital General Universitario de Alicante
Luis Brieva: Hospital Universitari Arnau de Vilanova
Carlos López de Silanes: Hospital Universitario de Torrejón
Ana B. Caminero: Complejo Asistencial de Ávila
María Terzaghi: University of Toronto
Julia Gracia-Gil: Complejo Hospitalario Universitario de Albacete
Gustavo Saposnik: University of Toronto

The Patient: Patient-Centered Outcomes Research, 2021, vol. 14, issue 2, No 7, 248 pages

Abstract: Abstract Background Risk attitude is defined as the willingness to tolerate risk to achieve a greater expected return. Limited information is available on how relapsing–remitting multiple sclerosis people’s perceptions about disease trajectory and risk attitude may influence treatment choices. Methods A non-interventional study applying principles of behavioral economics was conducted to assess willingness to receive unwarranted high-efficacy disease-modifying therapy (DMT) according to best-practice guidelines. People with relapsing–remitting multiple sclerosis (PwRRMS) according to 2010 McDonald criteria completed a survey on symptom severity, risk preferences, and management of simulated case scenarios mimicking the current treatment landscape. PwRRMS’s choice for high-efficacy agents was established as the participant’s selection of monoclonal antibodies for case scenarios with at least 2 years of clinical and radiological stability. Results A total of 211 PwRRMS were studied (mean age 39.1 ± 9.5 years, 70.1% female, mean Expanded Disability Status Scale score 1.8 ± 1.1). Almost 50% (n = 96) opted for a high-efficacy DMT despite the lack of evidence of disease activity. Younger age and risk-seeking behavior were associated with an increased likelihood of selecting unwarranted high-efficacy DMT [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.02–3.93, p = 0.043, and OR 2.17, 95% CI 1.09–4.30, p = 0.027, respectively]. Clinical characteristics or subjective perception of symptom severity had no influence on participants’ treatment choices. Conclusion Identifying PwRRMS with risk-seeking behavior would be crucial to implementing specific educational strategies to manage information on disease prognosis, treatment expectations, and safety risk knowledge.

Date: 2021
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DOI: 10.1007/s40271-020-00454-3

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