BACKGROUND: The growing number of disease-modifying treatments (DMTs) for relapsing multiple sclerosis (RMS) highlights the need to consider patient preferences in treatment decisions, which could lead to better adherence and outcomes.
OBJECTIVE: To estimate and compare treatment preferences and stated adherence among patients with RMS.
METHODS: A web-based, discrete choice experiment survey presented 10 choices between pairs of hypothetical MS DMTs to patients who self-reported a physician diagnosis of RMS. Treatment attributes, informed by the literature and clinician input and tested in patient interviews, included chance of MS progression, years between relapses, risk of serious infection, route of delivery and frequency of administration, and chance of flu-like and gastrointestinal (GI) symptoms. Random-parameters logit was used to estimate part-worth utilities. Importance scores and preference shares were calculated to compare subsamples based on disability level and current treatment.
RESULTS: Of 301 patients who completed the survey: 56% rated their disability as normal or mild, 79% reported currently receiving treatment and 42% reported using an injectable DMT. Overall, respondents with normal or mild disability had significantly different preferences than respondents with moderate or worse disability (p less than 0.05). Patients with worse disability placed the most weight on reducing the chance of MS progression and risk of serious infection. Patients with normal or mild disability placed the most weight on avoiding injections with flu-like symptoms, followed by reducing the chance of progression. Patients using injectable DMTs had significantly different preferences than those who were not (p less than 0.05). Patients using injectable DMTs placed the most weight on reducing the chance of progression and risk of serious infection. Oral dosing with no side effects had the highest preference share, but IV administration every 6 months was preferred when oral dosing had moderate GI symptoms. The largest percentage of patients stated highest likely adherence to daily oral dosing and IV administration every 6 months and lowest likely adherence to daily injection and daily oral.
