Treatment Selection in Multiple Sclerosis: Results of a Physician Survey

Background: Multiple sclerosis (MS) is a complex, heterogeneous disease with multiple therapeutic options.  Little is known about how neurologists select available disease modifying therapies (DMTs) for their patients.

Objectives: The purpose of this study is to understand how neurologists make decisions regarding DMT prescribing for their patients with MS.

Methods: After obtaining IRB approval, members of a physician market research panel were sent an online study invitation with a link directing them to the survey website.  Survey data collection occurred from December 2012 to January 2013.  All physicians included in the study were required to be living in the United States and currently treating a minimum of 20 patients with MS.  MS specialists were defined as physicians with ≥40% of their patients having MS.  Survey questions were adapted so that medication-specific questions were only asked for medications that the physician currently prescribes. 

Results: A total of 102 physicians (n=63 neurologists; n=39 MS specialists) met all study inclusion criteria and consented to participate in the study.  Most physicians (81.4%) were male; the mean (SD) years in practice since completing medical training was 16.4 (8.6) years.  Overall, the most commonly prescribed DMTs were glatiramer acetate, interferon beta-1a subcutaneous, and interferon beta-1a intramuscular.  Approximately 5.5% of these physicians’ MS patients were untreated, with individual physician reports ranging from 0% to 23% of patients not currently on therapy for MS.  According to physicians, the most important medication attributes in patients initiating their first DMT—in order of importance—were efficacy, safety, tolerability, patient preference, and convenience.  Nearly all physicians (95.1%) reported they would switch medications due to increase in relapse frequency.  MRI worsening and disability worsening without relapse were reported to influence the decision to switch medications in 74.5% and 72.5% of physicians, respectively.

Conclusions: Our survey of 102 physicians showed that on average, very few patients (5.5%) with MS receive no treatment for their disease.  The most important medication attribute influencing DMT selection for patient initiating therapy was efficacy.  Similarly, relapse frequency was reported as the primary concern that would prompt a medication switch.