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Albarraq RH, Alhujaili NA, Alshehri ZI, Alqarni AM, Bawareth RM. Anticipated Stigma among Patients with Multiple Sclerosis in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:54-59. [PMID: 38362097 PMCID: PMC10866384 DOI: 10.4103/sjmms.sjmms_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/06/2023] [Accepted: 08/09/2023] [Indexed: 02/17/2024]
Abstract
Background Social stigma is a major problem among patients with multiple sclerosis (MS), which can affect their quality of life. There is limited research from Saudi Arabia on the anticipated stigma among patients with MS. Objectives To determine the levels of anticipated stigma and its predictors in patients with MS in Saudi Arabia. Methods This cross-sectional study included adult patients with MS across Saudi Arabia. Sociodemographic and medical information, including age, gender, marital status, educational level, duration of disease, number of MS episodes in the past 12 months, previous diagnosis of mental illness, and performing activities of daily living without assistance, were collected. Anticipated stigma was measured using an Arabic version of the Chronic Illness Anticipated Stigma Scale. Results A total of 222 patients with MS were included. Moderate to severe anticipated stigma was found among 70.4% of the patients. The highest anticipated stigma mean score was from work colleagues (2.96/5). Predictors of stigma were age (P = 0.049), gender (P = 0.016), marital status (P = 0.015), education level (P = 0.003), number of MS episodes in the previous year (P < 0.001), and previous diagnosis of a mental disorder (P = 0.001). Conclusions The findings of this study indicate the need for developing programs that reduce the anticipated stigma among patients with MS in Saudi Arabia.
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Affiliation(s)
| | - Naseem Abdulmohi Alhujaili
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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Guilcher SJ, Cadel L, He A, Cimino SR, Ahmed M, Ho CH, Hitzig SL, McCarthy LM, Patel T, Hahn-Goldberg S, Lofters AK, Packer TL. Medication self-management toolkits for adults with multiple sclerosis: A scoping review. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100282. [PMID: 37396110 PMCID: PMC10314208 DOI: 10.1016/j.rcsop.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Background Multiple sclerosis (MS) is an autoimmune disease that is often treated with multiple medications. Managing multiple medications, also known as polypharmacy, can be challenging for persons with MS. Toolkits are instructional resources designed to promote behaviour change. Toolkits may support medication self-management for adults with MS, as they have been useful in other populations with chronic conditions. Objective The main purpose of this review was to identify and summarize medication self-management toolkits for MS, as related to the design, delivery, components, and measures used to evaluate implementation and/or outcomes. Methods A scoping review was conducted following guidelines by JBI. Articles were included if they focused on adults (18 years or older) with MS. Results Six articles reporting on four unique toolkits were included. Most toolkits were technology-based, including mobile or online applications, with only one toolkit being paper-based. The toolkits varied in type, frequency, and duration of medication management support. Varying outcomes were also identified, but there were improvements reported in symptom management, medication adherence, decision-making, and quality of life. The six studies were quantitative in design, with no studies exploring the user experience from a qualitative or mixed-methods design. Conclusions There is limited research on medication self-management toolkits among adults with MS. Future development, implementation, and evaluation mixed-methods research are needed to explore user experiences and overall design of toolkits.
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Affiliation(s)
- Sara J.T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario L5B1B8, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5G1V7, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario M2M2G1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario M5T3M6, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario L5B1B8, Canada
| | - Andrea He
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
| | - Stephanie R. Cimino
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5G1V7, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario M2M2G1, Canada
| | - Maham Ahmed
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
| | - Chester H. Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta T6G2G4, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5G1V7, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario M2M2G1, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5G1V7, Canada
| | - Lisa M. McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario L5B1B8, Canada
- School of Pharmacy, University of Waterloo, Kitchener, Ontario N2G 1C5, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario M5G1V7, Canada
- Women's College Research Institute, Toronto, Ontario M5G1N8, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Ontario N2G 1C5, Canada
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, Ontario N2J0E2, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario M5S3M2, Canada
- OpenLab, University Health Network, Toronto, Ontario M5G2C4, Canada
| | - Aisha K. Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario M5G1V7, Canada
- Women's College Research Institute, Toronto, Ontario M5G1N8, Canada
| | - Tanya L. Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Nova Scotia B3H4R2, Canada
- Department of Nursing, Umeå University, Umeå, Sweden
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3
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Akuffo-Addo E, Udounwa T, Chan J, Cauchi L. Exploring Biologic Treatment Hesitancy Among Black and Indigenous Populations in Canada: a Review. J Racial Ethn Health Disparities 2023; 10:942-951. [PMID: 35476223 PMCID: PMC9045033 DOI: 10.1007/s40615-022-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Biologics are becoming an increasingly important part of patient care across Canada. Recent studies from the USA show that Black patients are less likely than White patients to receive biologic treatment for several medical conditions. The relative lack of race-based data in Canada makes it difficult to replicate such studies in Canada. As a result, there is a paucity of literature that explores the association between biologic usage and race in Canada. Our review aims to explore the factors that might be driving racial treatment disparity in Canada that likely parallels the inequalities found in the USA. We provide a summary of the available literature on the factors that contribute to biologic treatment hesitancy among Black and Indigenous populations in Canada. We highlight several solutions that have been proposed in the literature to address biologic treatment hesitancy. Our review found that biologic treatment decision at the individual level can be very complex as patient's decisions are influenced by social inputs from family and trusted community members, biologic-related factors (negative injection experience, fear of needles, formulation, and unfamiliarity), cultural tenets (beliefs, values, perception of illness), and historical and systemic factors (past research injustices, socioeconomic status, patient-physician relationship, clinical trial representation). Some proposed solutions to address biologic treatment hesitancy among Black and Indigenous populations include increasing the number of Black and Indigenous researchers involved in and leading clinical trials, formally training physicians and healthcare workers to deliver culturally competent care, and eliminating financial barriers to accessing medications. Further research is needed to characterize and address race-based new treatment inequalities and hesitancy in Canada.
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Affiliation(s)
- Edgar Akuffo-Addo
- Undergraduate Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.
| | - Theodora Udounwa
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Chan
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Laura Cauchi
- Medical Information, Amgen Canada Inc., Mississauga, ON, Canada
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Hauer L, Sellner J. Diroximel Fumarate as a Novel Oral Immunomodulating Therapy for Relapsing Forms of Multiple Sclerosis: A Review on the Emerging Data. Drug Des Devel Ther 2022; 16:3915-3927. [PMID: 36388086 PMCID: PMC9663167 DOI: 10.2147/dddt.s236926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disorder of the central nervous system. Disease-modifying drugs (DMDs) and subsequent adherence are crucial for preventing reversible episodes of neurological dysfunction and delayed onset of progressive accumulation of irreversible deficits. Yet, side effects may limit their usage in clinical practice. Gastrointestinal (GI) side effects are a significant limitation of the use of dimethyl fumarate (DMF), the most frequently prescribed oral DMD in MS worldwide. Diroximel fumarate (DRF) is a second-generation oral fumaric acid ester (FAE) that was developed as a formulation with better GI tolerability. The improved tolerability is assumed to be related to a lower synthesis of gut-irritating methanol. Other explanations for DRF’s lower extent of GI irritation include a more modest off-target activity due to its chemical structure. The superior GI tolerability of DRF compared to DMF could be proven in clinical trials and lead to approval of DRF for the treatment of relapsing forms of MS/relapsing-remitting MS (United States Food and Drug Administration and European Medicines Agency, respectively). Here, we summarize the mode of action of oral FAE and compare the chemical and physiological characteristics of DMF and DRF. Moreover, we discuss the adverse effects of FAE and introduce the emerging preclinical and trial data leading to the approval of DRF in MS. This article additionally reviews our current understanding of coronavirus disease 2019 (COVID-19) and the efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination in people treated with FAE.
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Affiliation(s)
- Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
- Correspondence: Johann Sellner, Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr. 67, Mistelbach, 2130, Austria, Tel +2572/9004-12850, Fax +2572/9004-49281, Email
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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.
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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
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Seah THS, Almahmoud S, Coifman KG. Feel to Heal: Negative Emotion Differentiation Promotes Medication Adherence in Multiple Sclerosis. Front Psychol 2022; 12:687497. [PMID: 35082708 PMCID: PMC8784965 DOI: 10.3389/fpsyg.2021.687497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
Multiple Sclerosis (MS) is a debilitating chronic autoimmune disease of the central nervous system that results in lower quality of life. Medication adherence is important for reducing relapse, disease progression, and MS-related symptoms, particularly during the early stages of MS. However, adherence may be impacted by negative emotional states. Therefore, it is important to identify protective factors. Past research suggests that the ability to discriminate between negative emotional states, also known as negative emotion differentiation (NED), may be protective against enactment of maladaptive risk-related behaviors. However, less is known as to how NED may promote adaptive health behaviors such as medication adherence. Utilizing weekly diaries, we investigated whether NED moderates the association between negative affect and medication adherence rates across 58 weeks among patients (n = 27) newly diagnosed with MS (following McDonald criteria). Results revealed that NED significantly moderated the relationship between negative affect and medication adherence. Specifically, greater negative affect was associated with lower adherence only for individuals reporting low NED. However, this link disappeared for those reporting moderate to high NED. Building upon past research, our findings suggest that NED may promote adaptive health behaviors and have important clinical implications for the treatment and management of chronic illness.
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Affiliation(s)
- T. H. Stanley Seah
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
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An implantable device to treat multiple sclerosis: A discrete choice experiment on patient preferences in three European countries. J Neurol Sci 2021; 428:117587. [PMID: 34364148 DOI: 10.1016/j.jns.2021.117587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/27/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (MS) take their treatment via pills, injections or infusions. A novel mode of disease-modifying treatment administration, an implantable device, is under development. This study determined MS patient preferences for three modes of first-line treatment administration (implant, pills, injectables), and trade-offs regarding treatment characteristics. METHODS A survey including a discrete choice experiment was conducted among MS patients in the Netherlands, France, and the United Kingdom. Respondents had to repeatedly choose between various treatment scenarios with four treatment characteristics: risk of relapse, reduction of disease progression, risk of side effects and mode of administration. Data was analysed using a panel latent class logit model. RESULTS Based on the preferences of 753 MS patients (response rate 7%: 753/11202), two latent classes were identified (class probability of 74% vs 26%). Persons with relapsing-remitting MS and who administered medication via injections generally preferred any treatment over no treatment. Patients who could walk without an aid were more likely to prefer no treatment. Reducing disease progression was the most important treatment characteristic class 1. Mode of administration was the most important characteristic in class 2. Patients were willing to accept an increase in risk of relapse and disease progression to get their treatment via an implant rather than injections. Predicted uptake was the highest for the implant, followed by pills, injections, and no treatment. CONCLUSION We found that a drug-delivery implant could be a potential addition to the MS treatment landscape: MS patients are willing to trade-off risk of relapse and disease progression for an implant, and predicted uptake for an implant is relatively high.
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Wundes A, Wray S, Gold R, Singer BA, Jasinska E, Ziemssen T, de Seze J, Repovic P, Chen H, Hanna J, Messer J, Miller C, Naismith RT. Improved gastrointestinal profile with diroximel fumarate is associated with a positive impact on quality of life compared with dimethyl fumarate: results from the randomized, double-blind, phase III EVOLVE-MS-2 study. Ther Adv Neurol Disord 2021; 14:1756286421993999. [PMID: 33796143 PMCID: PMC7985943 DOI: 10.1177/1756286421993999] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/15/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Diroximel fumarate (DRF) is a novel oral fumarate approved for relapsing forms of multiple sclerosis (MS). DRF demonstrated significantly improved gastrointestinal (GI) tolerability versus dimethyl fumarate (DMF) with fewer days of Individual Gastrointestinal Symptom and Impact Scale (IGISIS) scores ⩾2, GI adverse events (AEs), and treatment discontinuations due to GI AEs. Our aim was to evaluate the impact of GI tolerability events on quality of life (QoL) for patients with relapsing–remitting MS who received DRF or DMF in EVOLVE-MS-2. Methods: A post hoc analysis was conducted in patients who were enrolled in the randomized, blinded, 5-week, EVOLVE-MS-2 [ClinicalTrials.gov identifier: NCT03093324] study of DRF versus DMF. Patients completed daily IGISIS and Global GISIS (GGISIS) eDiary questionnaires to assess GI symptom intensity and interference with daily activities and work. Results: In total, 504 patients (DRF, n = 253; DMF, n = 251) received study drug and 502 (DRF, n = 253; DMF, n = 249) completed at least one post-baseline questionnaire. With DRF, GI symptoms were less likely to interfere ‘quite a bit’ or ‘extremely’ with regular daily activities [IGISIS: DRF, 9.5% (24/253) versus DMF, 28.9% (72/249)] or work productivity [GGISIS: DRF, 6.1% (10/165) versus DMF, 11.3% (18/159)]. DRF-treated patients had fewer days with ⩾1 h of missed work (DRF, 43 days, n = 20 versus DMF, 88 days, n = 26). DMF-treated patients reported highest GI symptom severity and missed work at week 2–3 shortly after completing the titration period, which coincided with the majority of GI-related treatment discontinuations [58.3% (7/12)]. GI tolerability AEs [DRF, 34.8% (88/253); DMF, 48.2% (121/251)], concomitant symptomatic medication use [DRF, 19.3% (17/88) versus DMF, 30.6% (37/121)], and GI-related discontinuations (DRF, 0.8% versus DMF, 4.8%) were lower with DRF versus DMF. Conclusions: The improved GI tolerability with DRF translated into clinically meaningful benefits to QoL, as patients experienced less impact on daily life and work and required less concomitant symptomatic medication use. Trial registration: [ClinicalTrials.gov identifier: NCT03093324]
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Affiliation(s)
- Annette Wundes
- Department of Neurology, University of Washington Medical Center, Seattle, WA, USA
| | - Sibyl Wray
- Hope Neurology MS Center, Knoxville, TN, USA
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Barry A Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, St. Louis, MO, USA
| | - Elzbieta Jasinska
- Collegium Medicum UJK and Clinical Center, RESMEDICA, Kielce, Poland
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Jerome de Seze
- Strasbourg University Hospital and Clinical Investigation Center, INSER 1434, Strasbourg, France
| | - Pavle Repovic
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | | | | | - Jordan Messer
- Biogen, 225 Binney Street, Cambridge, MA 02142-1031, USA
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Visser LA, De Mul M, Redekop WK. Innovative Medical Technology and the Treatment Decision-Making Process in Multiple Sclerosis: A Focus Group Study to Examine Patient Perspectives. Patient Prefer Adherence 2021; 15:927-937. [PMID: 33994779 PMCID: PMC8114356 DOI: 10.2147/ppa.s306132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Disease-modifying therapies are given to people with multiple sclerosis (MS) to reduce disease progression and relapse frequency. Current modes of administration include oral, injectable and infusion therapy and the treatment decision-making process is complex. A novel mode of treatment administration, an implantable device, is currently under development, yet patient attitudes about the device are unknown. The aim of this study was 1) to understand the treatment decision-making process from the patient perspective and 2) to explore the possible acceptance of an implant to treat MS. METHODS Focus groups with people with MS were conducted in the Netherlands. Three topics were addressed: the treatment decision-making process, the current treatment landscape, and attitudes about the implantable device. All focus groups were recorded and transcribed and data were analyzed by raw data coding and creating themes. An online survey was conducted in the Netherlands to quantify interest in an implant. RESULTS Two focus group sessions were held (n=16 participants) and n=93 persons filled out the survey. The main theme that emerged was the constant uncertainty persons with MS face throughout their disease course and during treatment decisions (when to start, stop, continue or switch treatment). Patients were generally positive towards the implant but felt that efficacy and safety should be guaranteed. CONCLUSION People with MS want some form of control over their disease and treatment course. New medical technologies, such as an implant, may enhance the treatment landscape and with caution we postulate that it may be accepted by patients as a new mode of administration, though further research is needed. For medical technologies to be successful, patients should be engaged early on in the design process.
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Affiliation(s)
- L A Visser
- Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Correspondence: L A Visser Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle (J) Building, Room J8-15, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, the NetherlandsTel +31 10 408 8648 Email
| | - M De Mul
- Health Services Management & Organization, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - W K Redekop
- Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Manzano A, Eskyté I, Ford HL, Pavitt SH, Potrata B, Schmierer K, Chataway J, Webb EJD, Meads D, Pepper G, Bekker HL. Patient perspective on decisions to switch disease-modifying treatments in relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2020; 46:102507. [PMID: 32979733 DOI: 10.1016/j.msard.2020.102507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/14/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are now large cohorts of people with relapsing-remitting multiple sclerosis (pwRRMS) who have taken several Disease-Modifying Treatments (DMTs). Studies about switching DMTs mostly focus on clinical outcomes rather than patients' decision-making. Neurologists are now required to support decisions at various times during the relapsing disease course and they do so with concerns about DMTs risks. This qualitative study investigates how pwRRMS weigh up the pros and cons of DMTs, focusing on perceptions of effectiveness and risks when new treatments are considered. OBJECTIVE To increase understanding of people's experiences of decision-making when switching DMTs. METHODS 30 semi-structured interviews were conducted with pwRRMS in England. 16 participants had switched DMT and their experiences were compared with those who had only taken one DMT. Interviews were analysed thematically to answer: what main factors influence people's decision-making to switch DMTs and why? RESULTS Of the 16 participants with experience of switching DMT, eight had taken two or more DMTs; eight had taken three or more. Two was the DMT median. This study demonstrated that despite the term "switching" implying that similar treatments are inter-changeable, for pwRRMS taking new treatments involves different emotions, routines, risks, prognosis and communication experiences. Two meta themes identified were: 1) A distinctive, rapid and emotional decision-making process where old emotions related to MS prognosis are revisited. 2) Switching has a different impact on communication for escalation or de-escalation processes. CONCLUSION Switching DMT involves different routines, risks, prognosis and communication experiences. These decisions are emotionally difficult because of the fear about transitioning to secondary progressive MS, and DMT effectiveness uncertainty. Patient centred decision aids should include information about first and consecutive treatment decisions.
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Affiliation(s)
- A Manzano
- School of Sociology & Social Policy, University of Leeds, Leeds, LS2 9JT, United Kingdom.
| | - I Eskyté
- Centre for Disability Studies, University of Leeds, Leeds, United Kingdom
| | - H L Ford
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - S H Pavitt
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - B Potrata
- Independent Consultant, Rotterdam, the Netherlands
| | - K Schmierer
- Blizard Institute (Neuroscience), Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - J Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, United Kingdom
| | - E J D Webb
- Leeds Institute for Health Science, University of Leeds, Leeds, United Kingdom
| | - D Meads
- Leeds Institute for Health Science, University of Leeds, Leeds, United Kingdom
| | | | - H L Bekker
- Leeds Institute for Health Science, University of Leeds, Leeds, United Kingdom
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11
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Garabedian M, Perrone E, Pileggi C, Zimmerman V. Support Group Participation: Effect on Perceptions of Patients with Newly Diagnosed Multiple Sclerosis. Int J MS Care 2020; 22:115-121. [PMID: 32607073 DOI: 10.7224/1537-2073.2018-099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Patients newly diagnosed as having multiple sclerosis (MS) face an overwhelming number of questions about how it will affect their lives. Participation in a support group is one way to obtain information and receive support from others. However, existing support groups are often attended by patients with significant disability, resulting in newly diagnosed patients being hesitant to return. Methods This qualitative pilot study explored perceptions of patients with newly diagnosed MS before and after participation in two monthly meetings. A support group was conducted each month using nursing staff, a physician, and a social worker. Prior to the first meeting, participants were asked to complete a questionnaire with open-ended questions to share their thoughts about how MS may affect their lives. After the two meetings, they were asked to complete the same questionnaire again. Results Eight themes were identified: uncertain disease course; insecure future; physical, emotional, and cognitive impacts; effect on relationships with family and/or spouse/significant other; ability to develop future relationship with significant other; impact on career plans; impact on ability to achieve future goals; and impact on ability to care for self and family. Five of six participants who attended both meetings and one of four who attended only the first meeting expressed a change in their perception of how MS may affect their lives. Conclusions A support group dedicated exclusively to newly diagnosed patients may provide an opportunity for patients to experience a change in perceptions of MS.
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Desborough J, Brunoro C, Parkinson A, Chisholm K, Elisha M, Drew J, Fanning V, Lueck C, Bruestle A, Cook M, Suominen H, Tricoli A, Henschke A, Phillips C. 'It struck at the heart of who I thought I was': A meta-synthesis of the qualitative literature examining the experiences of people with multiple sclerosis. Health Expect 2020; 23:1007-1027. [PMID: 32578287 PMCID: PMC7696124 DOI: 10.1111/hex.13093] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023] Open
Abstract
Background People with multiple sclerosis (MS) have varied experiences and approaches to self‐management. This review aimed to explore the experiences of people with MS, and consider the implications of these experiences for clinical practice and research. Methods A meta‐synthesis of the qualitative literature examining experiences of people with MS was conducted using systematic searches of ProQuest, PubMed, CINAHL and PsycINFO. We incorporated feedback from team members with MS as expert patient knowledge‐users to capture the complex subjectivities of persons with lived experience responding to research on lived experience of the same disease. Results Of 1680 unique articles, 77 met the inclusion criteria. We identified five experiential themes: (a) the quest for knowledge, expertise and understanding, (b) uncertain trajectories (c) loss of valued roles and activities, and the threat of a changing identity, (d) managing fatigue and its impacts on life and relationships, and (f) adapting to life with MS. These themes were distributed across three domains related to disease (symptoms; diagnosis; progression and relapse) and two contexts (the health‐care sector; and work, social and family life). Conclusion The majority of people in the studies included in this review expressed a determination to adapt to MS, indicating a strong motivation for people with MS and clinicians to collaborate in the quest for knowledge. Clinicians caring for people with MS need to consider the experiential and social outcomes of this disease such as fatigue and the preservation of valued social roles, and incorporate this into case management and clinical planning.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Bruestle
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Matthew Cook
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hanna Suominen
- School of Computer Science, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Antonio Tricoli
- Research School of Electrical Energy & Materials Engineering, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Adam Henschke
- National Security College, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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Oreja-Guevara C. Family planning is the second most relevant factor for treatment decisions after disease activity - No. Mult Scler 2020; 26:642-643. [PMID: 32081082 DOI: 10.1177/1352458520902343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain/Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), IdISSC, Madrid, Spain
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