First-Line Treatment Preference in Relapsing-Remitting Multiple Sclerosis: An Online Choice Study in Patients and Physicians

Background: Several disease modifying treatments (DMTs) are available for relapsing-remitting multiple sclerosis (RRMS) that vary on features such as efficacy, safety, tolerability, and convenience.

Objectives: To evaluate RRMS patients’ and neurologists’ preference for first-line DMT selection

Methods: Patients were recruited online from PatientsLikeMe, a community for chronic disease patients. Patient inclusion criteria were: Relapsing remitting MS diagnosis, ≥18 years old, U.S. resident, and logged on to PatientsLikeMe ≥1 time (past 90 days). Physicians recruited from the WebMD network were US board certified neurologists (3 to 35 years post-residency). Patients and neurologists were asked to select their most and least preferred choice from a series of items:  efficacy parameters (slow disability progression, prevent new MRI lesions, reduce frequency of relapses), risk of serious side effects, tolerability, routes of administration (oral, injectable, infusion), cost, and neurologist recommendation (patient preference for neurologists). Patients’ and neurologists’ preferences were analyzed using Hierarchical Bayesian estimation.

Results: A total of 193 patients and 225 neurologists were recruited. Preference among patients and neurologists were similar. When selecting the first-line DMT, efficacy was most preferred and parenteral drug administration was least preferred by both patients and neurologists. Among patients and neurologists, the most endorsed items in decreasing order of importance were - slowing disability progression, decreased frequency of relapses, and preventing new MRI lesions. Neurologists also considered the risk of serious side effects as an important factor in first-line DMT selection. Preferences were similar across segments of patient age categories, sex, education, insurance and RRMS severity.

Conclusions: Patients and prescribers prioritize efficacy in treatment decision making. Knowledge of preferred attributes for first-line selection from the patient and neurologist perspective can help to better inform communication around treatment decision making.