1
|
Bernhardt AM, Oeller M, Friedrich I, Kocakavuk E, Nachman E, Peikert K, Roderigo M, Rossmann A, Schröter T, Wilhelm LO, Prell T, van Riesen C, Nieweler J, Katzdobler S, Weiler M, Jacobi H, Warnecke T, Claus I, Palleis C, Breimann S, Falkenburger B, Brandt M, Hermann A, Rumpf JJ, Claßen J, Höglinger G, Gandor F, Levin J, Giese A, Janzen A, Oertel WH. Risk willingness in multiple system atrophy and Parkinson's disease understanding patient preferences. NPJ Parkinsons Dis 2024; 10:158. [PMID: 39147806 PMCID: PMC11327309 DOI: 10.1038/s41531-024-00764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 07/29/2024] [Indexed: 08/17/2024] Open
Abstract
Disease-modifying therapeutics in the α-synucleinopathies multiple system atrophy (MSA) and Parkinson's Disease (PD) are in early phases of clinical testing. Involving patients' preferences including therapy-associated risk willingness in initial stages of therapy development has been increasingly pursued in regulatory approval processes. In our study with 49 MSA and 38 PD patients, therapy-associated risk willingness was quantified using validated standard gamble scenarios for varying severities of potential drug or surgical side effects. Demonstrating a non-gaussian distribution, risk willingness varied markedly within, and between groups. MSA patients accepted a median 1% risk [interquartile range: 0.001-25%] of sudden death for a 99% [interquartile range: 99.999-75%] chance of cure, while PD patients reported a median 0.055% risk [interquartile range: 0.001-5%]. Contrary to our hypothesis, a considerable proportion of MSA patients, despite their substantially impaired quality of life, were not willing to accept increased therapy-associated risks. Satisfaction with life situation, emotional, and nonmotor disease burden were associated with MSA patients' risk willingness in contrast to PD patients, for whom age, and disease duration were associated factors. An individual approach towards MSA and PD patients is crucial as direct inference from disease (stage) to therapy-associated risk willingness is not feasible. Such studies may be considered by regulatory agencies in their approval processes assisting with the weighting of safety aspects in a patient-centric manner. A systematic quantitative assessment of patients' risk willingness and associated features may assist physicians in conducting individual consultations with patients who have MSA or PD by facilitating communication of risks and benefits of a treatment option.
Collapse
Affiliation(s)
- Alexander Maximilian Bernhardt
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Marc Oeller
- Department for Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany.
| | - Isabel Friedrich
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Emre Kocakavuk
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Eliana Nachman
- VIB Center for Brain & Disease Research, Leuven, Belgium
- KU Leuven Department of Neurosciences, Leuven Brain Institute, Mission Lucidity, Leuven, Belgium
| | - Kevin Peikert
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany
- United Neuroscience Campus Lund-Rostock (UNC), Rostock, Germany
| | - Malte Roderigo
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Andreas Rossmann
- Department of Cardiology, Augustinum Klinik München, München, Germany
| | - Tabea Schröter
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | - Christoph van Riesen
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
| | - Johanna Nieweler
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Sabrina Katzdobler
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Heike Jacobi
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Stephan Breimann
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Bioinformatics, Wissenschaftszentrum Weihenstephan, Technical University of Munich, Freising, Germany
- Metabolic Biochemistry, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Björn Falkenburger
- Department of Neurology, TU Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Dresden, Germany
| | - Moritz Brandt
- Department of Neurology, TU Dresden, Dresden, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Dresden, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Jost-Julian Rumpf
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Joseph Claßen
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Günter Höglinger
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Florin Gandor
- Movement Disorders Clinic, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- MODAG GmbH, Wendelsheim, Germany
| | - Armin Giese
- MODAG GmbH, Wendelsheim, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Annette Janzen
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Wolfgang Hermann Oertel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Institute for Neurogenomics, Helmholtz Center for Environment and Health, München, Germany
| |
Collapse
|
2
|
Morgan A, Tallantyre E, Ontaneda D. The benefits and risks of escalation versus early highly effective treatment in patients with multiple sclerosis. Expert Rev Neurother 2023; 23:433-444. [PMID: 37129299 DOI: 10.1080/14737175.2023.2208347] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Multiple sclerosis is a chronic, demyelinating, inflammatory, and neurodegenerative disease of the central nervous system that affects over 2 million people worldwide. Considerable advances have been made in the availability of disease modifying therapies for relapsing-remitting multiple sclerosis since their introduction in the 1990s. This has led to debate regarding the optimal first-line treatment approach: a strategy of escalation versus early highly effective treatment. AREAS COVERED This review defines the strategies of escalation and early highly effective treatment, outlines the pros and cons of each, and provides an analysis of both the current literature and expected future directions of the field. EXPERT OPINION There is growing support for using early highly effective treatment as the initial therapeutic approach in relapsing-remitting multiple sclerosis. However, much of this support stems from observational real-world studies that use historic data and lack safety outcomes or randomized control trials that compare individual high versus low-moderate efficacy therapies, instead of the approaches themselves. Randomized control trials (DELIVER-MS, TREAT-MS) are needed to systemically and prospectively compare contemporary escalation versus early highly effective treatment approaches.
Collapse
Affiliation(s)
- Annalisa Morgan
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emma Tallantyre
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Daniel Ontaneda
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Masri HE, McGuire TM, Dalais C, van Driel M, Benham H, Hollingworth SA. Patient-based benefit-risk assessment of medicines: development, refinement, and validation of a content search strategy to retrieve relevant studies. J Med Libr Assoc 2022; 110:185-204. [PMID: 35440905 PMCID: PMC9014953 DOI: 10.5195/jmla.2022.1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Poor indexing and inconsistent use of terms and keywords may prevent efficient retrieval of studies on the patient-based benefit-risk assessment (BRA) of medicines. We aimed to develop and validate an objectively derived content search strategy containing generic search terms that can be adapted for any search for evidence on patient-based BRA of medicines for any therapeutic area. Methods: We used a robust multistep process to develop and validate the content search strategy: (1) we developed a bank of search terms derived from screening studies on patient-based BRA of medicines in various therapeutic areas, (2) we refined the proposed content search strategy through an iterative process of testing sensitivity and precision of search terms, and (3) we validated the final search strategy in PubMed by firstly using multiple sclerosis as a case condition and secondly computing its relative performance versus a published systematic review on patient-based BRA of medicines in rheumatoid arthritis. Results: We conceptualized a final search strategy to retrieve studies on patient-based BRA containing generic search terms grouped into two domains, namely the patient and the BRA of medicines (sensitivity 84%, specificity 99.4%, precision 20.7%). The relative performance of the content search strategy was 85.7% compared with a search from a published systematic review of patient preferences in the treatment of rheumatoid arthritis. We also developed a more extended filter, with a relative performance of 93.3% when compared with a search from a published systematic review of patient preferences in lung cancer.
Collapse
Affiliation(s)
- Hiba El Masri
- , PhD Candidate, School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Treasure M McGuire
- , Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia, Mater Pharmacy, Mater Health, Raymond Tce, South Brisbane, QLD, Australia
| | - Christine Dalais
- , University Library, The University of Queensland, Brisbane, QLD, Australia
| | - Mieke van Driel
- , Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Helen Benham
- , Department of Rheumatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | |
Collapse
|
4
|
EL Masri H, McGuire TM, van Driel ML, Benham H, Hollingworth SA. Dynamics of Patient-Based Benefit-Risk Assessment of Medicines in Chronic Diseases: A Systematic Review. Patient Prefer Adherence 2022; 16:2609-2637. [PMID: 36164323 PMCID: PMC9508999 DOI: 10.2147/ppa.s375062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A critical gap exits in understanding the dynamics of patient-based benefit-risk assessment (BRA) of medicines in chronic diseases during the disease journey. PURPOSE To systematically review and synthesize current evidence on the changes of patients' preferences about the benefits and risks of medicines during their disease journey including the influence of disease duration and severity, and previous treatment experience. METHODS A systematic review of studies identified in PubMed and Embase, from inception to November 2020, was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were eligible if they analyzed adult patient-based BRA of medicines with a chronic disease, based on at least one of the pre-specified dimensions: disease severity, disease duration, or previous treatment experience. RESULTS A total of 26,228 articles were identified and 105 were eligible for inclusion. Of these, 85 detected a variation in patient-based BRA of medicines with at least one of the pre-specified criteria. Patients with higher disease severity and more treatment experience have increased risk tolerance. It remains inconclusive whether disease duration directly affects the relative importance of a patient's preference. CONCLUSION Factors important for patients' BRA of their medicines during a chronic disease journey vary more with their clinical situation and previous treatment experience than with time since diagnosis. Due to the importance of these factors on patients' perspectives and potential impact on their decision-making and eventually their clinical outcomes, there is a need for more studies to assess the dynamics of patients' BRA in every disease.
Collapse
Affiliation(s)
- Hiba EL Masri
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Correspondence: Hiba EL Masri, School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Brisbane, Queensland, 4102, Australia, Tel +61 478512234, Email
| | - Treasure M McGuire
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Mater Pharmacy, Mater Health, Brisbane, Queensland, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Helen Benham
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Rheumatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | |
Collapse
|
5
|
Ford PJ, Fox RJ, Mercer MB, Cofield SS. Patient Perceptions of FDA Approval: Gaps in Education or Variation in Values? Neurol Clin Pract 2021; 11:273-279. [PMID: 34484926 DOI: 10.1212/cpj.0000000000001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/30/2020] [Indexed: 11/15/2022]
Abstract
Objective To assess perceptions and opinions about the Food and Drug Administration (FDA) approval process for disease-modifying therapies (DMT) in people living with multiple sclerosis (MS). Methods People living with MS were invited to complete a web-based survey of their perceptions of the FDA role and process for approval of MS medications. The survey asked about the role of the FDA, factors involved in the approval process, which voices should represent those with MS in deliberations about drug approval, and the level of comfort with uncertain safety of newly approved therapies. Results Three thousand thirty-three respondents met inclusion criteria for data analysis. Most respondents seemed to understand the role of the FDA, although only half understood a fundamental FDA role: balancing the risks and benefits when considering drug approval. Significant differences were observed in many areas between those who have and have not tried DMTs. Comfort with uncertainty was associated with several factors relating to side effects and benefits believed important for the FDA to consider. Most respondents reported that people who participated in the medication's clinical trial were particularly able to represent people living with MS. Conclusion Perceptions regarding the FDA and views of who should represent people living with MS varied between those who have and have not tried DMT. There is variability in personal values that should be recognized and taken into account when considering regulatory responsibilities. Interventions are needed to address educational gaps regarding the mission and trustworthiness of the FDA as an oversight body.
Collapse
Affiliation(s)
- Paul J Ford
- Neuroethics Program (PJF), Cleveland Clinic; Mellen Center for Multiple Sclerosis (RJF), Cleveland Clinic; Department of Bioethics (MBM), Cleveland Clinic, OH; and Department of Biostatistics (SSC), The University of Alabama at Birmingham
| | - Robert J Fox
- Neuroethics Program (PJF), Cleveland Clinic; Mellen Center for Multiple Sclerosis (RJF), Cleveland Clinic; Department of Bioethics (MBM), Cleveland Clinic, OH; and Department of Biostatistics (SSC), The University of Alabama at Birmingham
| | - Mary Beth Mercer
- Neuroethics Program (PJF), Cleveland Clinic; Mellen Center for Multiple Sclerosis (RJF), Cleveland Clinic; Department of Bioethics (MBM), Cleveland Clinic, OH; and Department of Biostatistics (SSC), The University of Alabama at Birmingham
| | - Stacey S Cofield
- Neuroethics Program (PJF), Cleveland Clinic; Mellen Center for Multiple Sclerosis (RJF), Cleveland Clinic; Department of Bioethics (MBM), Cleveland Clinic, OH; and Department of Biostatistics (SSC), The University of Alabama at Birmingham
| |
Collapse
|
6
|
Rahn AC, Solari A, Beckerman H, Nicholas R, Wilkie D, Heesen C, Giordano A. "I Will Respect the Autonomy of My Patient": A Scoping Review of Shared Decision Making in Multiple Sclerosis. Int J MS Care 2021; 22:285-293. [PMID: 33424485 DOI: 10.7224/1537-2073.2020-027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patient autonomy is a bioethical principle that was strengthened in the revised Declaration of Geneva. Shared decision making (SDM) is particularly relevant in the management of multiple sclerosis (MS) because many preference-sensitive decisions have to be made during the disease course. We aimed to summarize the available evidence on SDM in the MS field and to inform future research and practice. Methods We performed a scoping review by searching MEDLINE (past 5 years). Studies were included if they reported primary/secondary research and focused on SDM related to people with MS. Data were grouped into topics, with results presented in narrative form. Results From 865 references, we included 55 studies conducted mostly in Europe. Half of the studies were observational, followed by qualitative (20%), mixed-methods (17%), randomized controlled trials (RCTs, 5%), quasi-experimental (5%), and reviews (4%). Most studies addressed people with relapsing-remitting MS (85%); the remaining addressed health care professionals, patients' significant others, or a combination. We identified five main topics: decisions on disease-modifying drugs, decisions on chronic cerebrospinal venous insufficiency treatment, information provision and patient education, health literacy, and risk knowledge. Conclusions The high proportion of included studies on SDM in MS in Europe suggests an earlier adoption of these concepts in this area. Decisions on disease-modifying drugs was the prevalent topic. Only 5% of studies were RCTs, indicating that more research is needed to study the effectiveness of SDM interventions. Studies addressing people with primary and secondary progressive MS are also needed.
Collapse
|
7
|
Minacapelli E, Giordano A, Falautano M, Sangalli F, Pietrolongo E, Lorefice L, Cocco E, Lugaresi A, Comi G, Filippi M, Martinelli V. Risk attitude and personality in people with multiple sclerosis facing the choice of different disease-modifying therapy scenarios. J Neurol Sci 2020; 417:117064. [DOI: 10.1016/j.jns.2020.117064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
|
8
|
High-Efficacy Disease-Modifying Therapies in People with Relapsing-Remitting Multiple Sclerosis: The Role of Risk Attitude in Treatment Decisions. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:241-248. [PMID: 32975737 DOI: 10.1007/s40271-020-00454-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
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.
Collapse
|
9
|
Jakimovski D, Vaughn CB, Eckert S, Zivadinov R, Weinstock-Guttman B. Long-term drug treatment in multiple sclerosis: safety success and concerns. Expert Opin Drug Saf 2020; 19:1121-1142. [PMID: 32744073 DOI: 10.1080/14740338.2020.1805430] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The portfolio of multiple sclerosis (MS) disease modifying treatments (DMTs) has significantly expanded over the past two decades. Given the lifelong use of MS pharmacotherapy, understanding their long-term safety profiles is essential in determining suitable and personalized treatment. AREAS COVERED In this narrative review, we summarize the short-, mid-, and long-term safety profile of currently available MS DMTs categories. In addition to the initial trial findings, safety outcomes derived from long-term extension studies (≥5-20 years) and safety-based prescription programs have been reviewed. In order to better understand the risk-benefit ratio for each particular DMT group, a short description of the DMT-based efficacy outcomes has been included. EXPERT OPINION Long-term extension trials, large observational studies and real-world databases allow detection of rare and potentially serious adverse events. Two-year-long trials are unable to fully capture the positive and negative effects of immune system modulation and reconstitution. DMT-based monitoring programs can provide greater insights regarding safe use of MS medications in different patient populations and clinical settings. During the process of shared DMT decision, both MS care providers and their patients should be aware of an ever-expanding number of drug-based adverse events and their influence on the risk-benefit analysis.
Collapse
Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA
| | - Caila B Vaughn
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| | - Svetlana Eckert
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA.,Translational Imaging Center at Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Stat37$e University of New York , Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| |
Collapse
|
10
|
Anderson KD, Bryden AM, Moynahan M. Risk-benefit value of upper extremity function by an implanted electrical stimulation device targeting chronic cervical spinal cord injury. Spinal Cord Ser Cases 2019; 5:68. [PMID: 31632726 PMCID: PMC6786403 DOI: 10.1038/s41394-019-0213-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022] Open
Abstract
Study design A cross-sectional stated-preference survey using direct-assessment questions. Objective To determine the relative value placed on different outcomes to be used in a pivotal trial for the upper extremity configuration of the Networked Neuroprosthesis (NNP) as well as the tolerance of the expected adverse event profile. Setting Academic medical center in the United States. Methods Distribution of an online survey to adults living with tetraplegia; extent of agreement with each question/statement was obtaining using a 1-7 Likert scale. Results There were 8 statements about potential benefits in arm/hand function; for all statements, more than 70% of participants rated the functions as "1-very important" to regain. There were variable degrees of concern related to risks that could occur during the 30-day post-surgical period and increasing degrees of concern related to risks that could occur in the first 5 years, potentially due to the device, based on the increasing degree of invasiveness of the intervention required to address the event. When analysing the results based on all degrees of interest, more than 64% of responders were interested in getting the NNP with a success rate threshold as low as 50% regardless of time post-injury. Chi-squared analyses revealed some associations between responses and sex, injury level, and injury duration; however, none of these were statistically significant upon post-hoc analysis. Conclusion Data here indicate that people with tetraplegia are highly interested in a range of arm/hand functions and are tolerant of expected risks that may be associated with implanted neuroprosthetics. Sponsorship The Institute for Functional Restoration funded this project through a sub-contract to K.D. Anderson from a larger Special Projects Award (grant number FP0020773) from the Craig H. Neilsen Foundation.
Collapse
Affiliation(s)
- Kim D. Anderson
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL USA
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
| | - Anne M. Bryden
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH USA
| | - Megan Moynahan
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
| |
Collapse
|
11
|
Fox RJ, Cosenza C, Cripps L, Ford P, Mercer M, Natarajan S, Salter A, Tyry T, Cofield SS. A survey of risk tolerance to multiple sclerosis therapies. Neurology 2019; 92:e1634-e1642. [PMID: 30867272 PMCID: PMC6448448 DOI: 10.1212/wnl.0000000000007245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/27/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine tolerance to various risk scenarios associated with current multiple sclerosis (MS) therapies. METHODS People with MS from the North American Research Committee on Multiple Sclerosis Registry's online cohort and the National Multiple Sclerosis Society were invited to complete a questionnaire on tolerance to real-world risks associated with a hypothetical therapy. Multiple risks levels were presented, including skin rash, infection, kidney injury, thyroid injury, liver injury, and progressive multifocal leukoencephalopathy (PML). RESULTS Both PML and kidney injury had the lowest risk tolerance (RT) at 1:1,000,000, and thyroid and infection risks had the highest tolerance at 1:1,000. Men, younger individuals, and participants with greater disability reported a higher tolerance to all risk scenarios. Those who were currently taking an MS therapy reported higher tolerance than those not taking any therapy. Participants taking infusion therapies reported high tolerance to all risks, and those taking injectables reported a lower tolerance. CONCLUSION People with MS displayed a wide range of RT for MS therapies. Our study identified sex, age, disability, and current disease-modifying therapy use to be associated with RT.
Collapse
Affiliation(s)
- Robert J Fox
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham.
| | - Carol Cosenza
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - Lauren Cripps
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - Paul Ford
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - MaryBeth Mercer
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - Sneha Natarajan
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - Amber Salter
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - Tuula Tyry
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| | - Stacey S Cofield
- From the Mellen Center for Multiple Sclerosis, (R.J.F., S.N.), Department of Bioethics (P.F.), and Department of Bioethics (M.M.), Cleveland Clinic, OH; Center for Survey Research (C.C., L.C.), University of Massachusetts, Boston; Division of Biostatistics (A.S.), Washington University School of Medicine, St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; and Department of Biostatistics (S.S.C.), School of Public Health, University of Alabama, Birmingham
| |
Collapse
|
12
|
Bichuetti DB, Franco CA, Elias I, Mendonça ACR, Carvalho LFD, Diniz DS, Tur C, Tintoré M, Oliveira EMLD. Multiple sclerosis risk perception and acceptance for Brazilian patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:6-12. [PMID: 29364388 DOI: 10.1590/0004-282x20170167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 09/14/2017] [Indexed: 01/22/2023]
Abstract
The perception of multiple sclerosis (MS) severity and risk associated with therapies might influence shared decision making in different countries. We investigated the perception of MS severity and factors associated with risk acceptance in Brazil in 96 patients with relapsing-remitting MS using a standardized questionnaire and compared this with two European cohorts. Multiple sclerosis was perceived as a very severe disease and the risk of developing progressive multifocal leukoencephalopathy due to natalizumab was seen as moderate to high. Seventy-six percent considered a risk of 1:1,000, or higher, an impediment for natalizumab use. Older age was the only variable associated with higher risk acceptance and our patients showed a more conservative profile than German and Spanish patients. Our patients perceived MS severity and progressive multifocal leukoencephalopathy risk similarly to elsewhere, but their willingness to take risks was more conservative. This should be considered when discussing therapeutic options and it might have an impact on guideline adaptations.
Collapse
Affiliation(s)
| | - Carolina Azze Franco
- Universidade Federal de São Paulo, Disciplina de Neurologia, São Paulo SP, Brasil
| | - Isaac Elias
- Universidade Federal de São Paulo, Disciplina de Neurologia, São Paulo SP, Brasil
| | - Andreia C R Mendonça
- Universidade Federal de Goiás, Faculdade Estácio de Sá de Goiás,Centro de Referência e Investigação em Esclerose Múltipla, Goiânia GO, Brasil
| | - Lorraine Fiama Diniz Carvalho
- Universidade Federal de Goiás, Faculdade Estácio de Sá de Goiás,Centro de Referência e Investigação em Esclerose Múltipla, Goiânia GO, Brasil
| | - Denise Sisterolli Diniz
- Universidade Federal de Goiás,Centro de Referência e Investigação em Esclerose Múltipla, Goiânia GO, Brasil
| | - Carmen Tur
- Universitat Autònoma de Barcelona, Hospital Universitari Valld'Hebron, Centre of Catalonia, Department of Neurology-Neuroimmunology and Multiple Sclerosis, Barcelona Spain.,University College London, Institute of Neurology, Department of Neuroinflammation, London, United Kingdom
| | - Mar Tintoré
- Universitat Autònoma de Barcelona, Hospital Universitari Valld'Hebron, Centre of Catalonia, Department of Neurology-Neuroimmunology and Multiple Sclerosis, Barcelona Spain
| | | |
Collapse
|
13
|
Cofield SS, Thomas N, Tyry T, Fox RJ, Salter A. Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry. Int J MS Care 2017; 19:303-312. [PMID: 29270088 DOI: 10.7224/1537-2073.2016-091] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P < .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P < .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference.
Collapse
|
14
|
Driedger SM, Maier R, Marrie RA, Brouwers M. Caught in a no-win situation: discussions about CCSVI between persons with multiple sclerosis and their neurologists - a qualitative study. BMC Neurol 2017; 17:176. [PMID: 28882115 PMCID: PMC5590111 DOI: 10.1186/s12883-017-0954-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/27/2017] [Indexed: 12/05/2022] Open
Abstract
Background In recent years, shared decision making (SDM) has been promoted as a model to guide interactions between persons with MS and their neurologists to reach mutually satisfying decisions about disease management – generally about deciding treatment courses of prevailing disease modifying therapies. In 2009, Dr. Paolo Zamboni introduced the world to his hypothesis of Chronic Cerebrospinal Venous Insufficiency (CCSVI) as a cause of MS and proposed venous angioplasty (‘liberation therapy’) as a potential therapy. This study explores the discussions that took place between persons with MS (PwMS) and their neurologists about CCSVI against the backdrop of the recent calls for the use of SDM to guide clinical conversations. Methods In 2012, study researchers conducted focus groups with PwMS (n = 69) in Winnipeg, Canada. Interviews with key informants were also carried out with 15 participants across Canada who were stakeholders in the MS community: advocacy organizations, MS clinicians (i.e. neurologists, nurses), clinical researchers, and government health policy makers. Results PwMS reported a variety of experiences when attempting to discuss CCSVI with their neurologist. Some found that there was little effort to engage in desired discussions or were dissatisfied with critical or cautious stances of their neurologist. This led to communication breakdowns, broken relationships, and decisions to autonomously access alternative opinions or liberation therapy. Other participants were appreciative when clinicians engaged them in discussions and were more receptive to more critical appraisals of the evidence. Key informants reported that they too had heard of neurologists who refused to discuss CCSVI with patients and that neurology as a whole had been particularly vilified for their response to the hypothesis. Clinicians indicated that they had shared information as best they could but recommended against seeking liberation therapy. They noted that being respectful of patient emotions, values, and hope were also key to maintaining good relationships. Conclusions While CCSVI proved a challenging context to carry out patient-physician discussions and brought numerous tensions to the surface, following the approach of SDM can minimize the potential for unfortunate outcomes as much as possible because it is based on principles of respect and more two-way communication. Electronic supplementary material The online version of this article (10.1186/s12883-017-0954-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ryan Maier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
15
|
Heesen C, Kleiter I, Meuth SG, Krämer J, Kasper J, Köpke S, Gaissmaier W. Benefit-risk perception of natalizumab therapy in neurologists and a large cohort of multiple sclerosis patients. J Neurol Sci 2017; 376:181-190. [DOI: 10.1016/j.jns.2017.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 01/27/2023]
|
16
|
Krämer J, Tenberge JG, Kleiter I, Gaissmaier W, Ruck T, Heesen C, Meuth SG. Is the risk of progressive multifocal leukoencephalopathy the real reason for natalizumab discontinuation in patients with multiple sclerosis? PLoS One 2017; 12:e0174858. [PMID: 28406921 PMCID: PMC5391008 DOI: 10.1371/journal.pone.0174858] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/16/2017] [Indexed: 12/29/2022] Open
Abstract
Background Progressive multifocal leukoencephalopathy (PML) is one of the major risks of natalizumab therapy. Despite introduction of the currently employed PML risk stratification algorithm, the incidence of natalizumab-associated PML cases is not decreasing. Objectives We addressed the following questions: How do natalizumab-treated multiple sclerosis patients and their treating physicians assess and deal with PML risk? Is PML risk the real reason for natalizumab discontinuation? Methods 699 natalizumab-treated multiple sclerosis patients and 99 physicians were included in this prospective observational study. Questionnaires were completed at 5 different time points. Patients were stratified into 5 subgroups according to the presence of PML risk factors (prior immunosuppression, anti-JCV antibody status, treatment duration). Patients with prior immunosuppression (n = 30, treated by n = 7 physicians) were excluded from analyses, because patient numbers were too small. Patients’ anti-JCV antibody index was not considered because data recruitment ended in 2014. Using Bayesian network and regression analysis, we examined the relationship between different patient- and physician-related factors and patients’ discontinuation of natalizumab. Results Patients of all subgroups and physicians assessed the PML risk as low. Overall patient adherence to natalizumab was high (87%). Only 13% of patients discontinued therapy. Natalizumab treatment cessation was associated with different patient- and physician-related factors (physicians’ assessment of general PML risk, number of treated patients per year, natalizumab treatment duration, relapses during the course of study) upon which only physicians’ judgment on treatment continuation, patients’ perception of personal PML risk, and JCV seroconversion showed significant relationships. Conclusion According to the currently employed risk stratification algorithm, the objective PML risk probably doesn’t play a dominant role in a patients’ decision to continue or stop natalizumab treatment. The decision-making process is rather guided by subjective views and experiences of patients and treating neurologists. Treating physicians should consider this discrepancy in their advice to improve the risk-benefit-ratio for the individual patient.
Collapse
Affiliation(s)
- Julia Krämer
- Department of Neurology, Clinic of Neurology and Institute of Translational Neurology, Westfälische Wilhelms University, Münster, Germany
- * E-mail: (JK); (SGM)
| | - Jan-Gerd Tenberge
- Department of Neurology, Clinic of Neurology and Institute of Translational Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef-Hospital, Ruhr-University-Bochum, Bochum, Germany
| | | | - Tobias Ruck
- Department of Neurology, Clinic of Neurology and Institute of Translational Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Christoph Heesen
- Department of Neurology, Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven G. Meuth
- Department of Neurology, Clinic of Neurology and Institute of Translational Neurology, Westfälische Wilhelms University, Münster, Germany
- * E-mail: (JK); (SGM)
| |
Collapse
|
17
|
Multiple sclerosis patients' understanding and preferences for risks and benefits of disease-modifying drugs: A systematic review. J Neurol Sci 2017; 375:107-122. [DOI: 10.1016/j.jns.2016.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
|
18
|
Delbue S, Comar M, Ferrante P. Natalizumab treatment of multiple sclerosis: new insights. Immunotherapy 2016; 9:157-171. [PMID: 28004598 DOI: 10.2217/imt-2016-0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Natalizumab is a monoclonal antibody directed against the α4 chain of the very late activating antigen 4 and α4β7 integrins, present on the leukocytes surface, used as monotherapy for the treatment of relapsing-remitting multiple sclerosis. It substantially reduces relapse rate and the accumulation of disability, but its use is associated with a very adverse event, that is the development of progressive multifocal leukoencephalopathy, a fatal demyelinating disease of the CNS, due to the lytic replication of the human polyomavirus JC. The main focus of the review is to describe the newest insights on natalizumab, its current use in the clinical practice, the natalizumab-treated patients' management and the risk stratification related to the progressive multifocal leukoencephalopathy development.
Collapse
Affiliation(s)
- Serena Delbue
- Department of Biomedical, Surgical & Dental Sciences, University of Milano, Milano, Italy
| | - Manola Comar
- Department of Medical Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal & Child Health-IRCCS 'Burlo Garofolo', 34137 Trieste, Italy
| | - Pasquale Ferrante
- Department of Biomedical, Surgical & Dental Sciences, University of Milano, Milano, Italy.,Health Direction, Istituto Clinico Città Studi, Milano, Italy
| |
Collapse
|
19
|
Glanz BI, Greeke E, LaRussa A, Stuart F, Rintell DJ, Chitnis T, Healy BC. Risk attitudes and risk perceptions in individuals with multiple sclerosis. Mult Scler J Exp Transl Clin 2016; 2:2055217316665406. [PMID: 28607735 PMCID: PMC5453630 DOI: 10.1177/2055217316665406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/25/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little is known about risk attitudes and risk perceptions in multiple sclerosis (MS). OBJECTIVES The objectives of this paper are to investigate the range of risk attitudes and risk perceptions and examine associations between risk attitudes and risk perceptions and demographic and clinical features of the disease. METHODS A total of 223 individuals completed a risk questionnaire. Risk attitude was measured using two rating scales and a standard gamble scenario. Risk perception was measured by asking participants to estimate the likelihood of disease progression and the likelihood of minor and serious side effects associated with common MS therapies. RESULTS Participants were risk neutral overall and risk averse on issues related to health and safety. There was a significant association between disease duration and risk attitude, with patients with longer disease duration showing greater tolerance for risk. On the standard gamble scenario, males were significantly more likely to take treatments with a likelihood of death of 1:10,000 or 1:100,000 than females. Individuals with higher disability or a progressive disease course were significantly more likely to expect progression at two, five and 10 years. CONCLUSION Individuals with MS demonstrate low tolerance for risk. Risk attitudes and perceptions are influenced by some demographic and clinical features of the disease.
Collapse
Affiliation(s)
| | - Emily Greeke
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, USA
| | - Allison LaRussa
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, USA
| | - Fiona Stuart
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, USA
| | | | | | - Brian C Healy
- Department of Neurology, Harvard Medical School, USA
| |
Collapse
|