Patient and neurologist preferences in the UK for relapsing–remitting multiple sclerosis treatments: findings from a discrete choice experiment

Abstract

Objective

To evaluate and compare patient and neurologist preferences for relapsing–remitting multiple sclerosis (RRMS) treatments with respect to benefits and risks associated with common and novel disease-modifying therapies, including brain volume loss (BVL).

Methods

Patients with non-highly-active RRMS and neurologists in the United Kingdom completed an online cross-sectional survey. Patients completed one discrete choice experiment (DCE) exercise and providers completed two, one focusing on treatment for non-highly-active RRMS and another focused on highly active RRMS. Respondents chose between two treatment profiles that varied on seven attributes identified in qualitative research: 2 year disability progression; 1 year relapse rate; rate of BVL; and risks of gastrointestinal symptoms, flu-like symptoms, infection and life-threatening event. Bayesian modeling was used to estimate attribute-level weighted preferences.

Results

Patients (n = 144) prioritized slowing the rate of BVL, followed by reducing risk of infection, rate of 2 year disability progression and 1 year relapse rate. For non-highly-active patients, neurologists (n = 101) prioritized slowing the rate of BVL, followed by reducing 2 year disability progression, risk of infection and 1 year relapse rate. For highly active patients, neurologists prioritized lowering the 1 year relapse rate, followed by slowing the rate of BVL and 2 year disability progression. In all three DCEs, rate of BVL was approximately twice as important as reducing the risks of flu-like symptoms, gastrointestinal symptoms and life-threatening event.

Conclusions

This study highlights similarities in treatment preferences for non-highly-active RRMS among patients and neurologists and differences in neurologists’ preferences for treating non-highly-active vs. highly active RRMS. This research identifies BVL as a treatment outcome that should be discussed when physicians engage in shared decision-making with patients.

Keywords:

• Multiple sclerosis
• patient preferences
• physician preferences
• brain volume loss
• cognitive function

Transparency

Declaration of funding

The study was sponsored by Bristol Myers Squibb, Princeton, NJ. The authors received medical writing support from Errol J. Philip PhD, who is a paid consultant of Kantar Health, and Jennifer Ken-Opurum PhD of Kantar Health, New York, NY, and editorial support from Samantha Rivera MS of Peloton Advantage LLC, an OPEN Health company, Parsippany, NJ, sponsored by Bristol Myers Squibb.

Author contributions

T.T., J.K. and K.B. contributed to the conception of the study. O.W., M.J.C.M., d.S.M. and K.B. were involved in data analysis. M.J.C.M. drafted the manuscript. All authors contributed to the design of the study, interpretation of the data and the critical review of the manuscript. All authors provided the final approval of the manuscript and agreed to be accountable for all aspects of the work.

Declaration of financial/other relationships

O.W., M.J.C.M., d.S.M. and K.B. have disclosed that they are employees of Kantar Health, who received funding from Bristol Myers Squibb to conduct this study. T.T. and J.K. have disclosed that they are employees and shareholders of Bristol Myers Squibb. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors acknowledge Errol J. Philip PhD and Jennifer Ken-Opurum PhD for their assistance with medical writing and Peloton Advantage LLC (Parsippany, NJ), an OPEN Health company, for editorial support.

Data availability statement

BMS policy on data sharing may be found at https://www.bms.com/researchers-and-partners/independent-research/data-sharing-request-process.html.