Skip to main content Skip to navigation

Latest MS research update - What factors influence people with MS when choosing a disease modifying therapy? - 18 November 2014

The MS Trust runs a weekly search for interesting and relevant research articles relating to multiple sclerosis using Medline, a specialised search engine for medical journals. The original abstracts to each of the articles can be accessed via the links provided.

For further information on any topic please contact the information team at info@mstrust.org.uk.


This week's highlighted research...

What factors influence people with MS when choosing a disease modifying therapy?

Research by topic areas...

Assessment tools
Basic Research
Causes of MS
Diagnosis
Disease modifying treatments
Paediatric MS
Physical activity
Prognosis
Provision of care
Psychological aspects
Rehabilitation
Stem cells
Symptoms and symptom management


What factors influence people with MS when choosing a disease modifying therapy?

Summary

There are now 10 disease modifying therapies (DMTs) available on the NHS in the UK. Such a range of options can mean that people with MS and their health professionals can be faced with several potential treatments to choose between. This study examined the treatment preferences of 156 people with MS and what factors influenced their preferences by presenting them with pairs of hypothetical treatment scenarios where they had to select which one they would choose.

Overall the study found that participants would prefer to take a pill, that did not need to be taken very often and had infrequent side effects. However preference switched to injections, if the pill had to be taken much more often than an injection and also when pills were associated with more frequent side effects.

The study authors conclude that their study suggests that route of administration and frequency of treatment are important considerations for people with MS when choosing which type of DMT they would prefer. However the authors do state that as their questionnaire involved hypothetical scenarios, many of the situations posed to the participants do not directly correspond to a particular DMT that is available and that there are several other characteristics associated with DMTs that they did not explore. So even though the study did not explore all of the factors that could influence a person's choice between potential treatment options, it gives some indication of how benefits and risks are weighed up in the decision process.


Background

Disease modifying therapies (DMTs) are a group of drugs for people with MS who have relapses, as they can decrease the number of relapses that someone experiences and also how severe each relapse is. There are now 10 DMTs available on the NHS in the UK, and as other drugs are being investigated in clinical trials, more drugs may become available in the future. Such a range of options can mean that people with MS and their health professionals can be faced with several potential treatment options to choose between. This study aimed to examine the treatment preferences of people with MS and what factors influenced their preferences.


How this study was carried out

156 people with relapsing remitting MS, who had been in contact with a university hospital in Germany took part in the study.

They completed two questionnaires. One collected information about their personal characteristics, (such as age, gender and education), their medical history of MS, their experiences with DMTs, including switching treatments and side effects. Finally they were asked "if you had a choice, which route of administration of treatment would you prefer? Pill, injection or infusion?".

The second questionnaire assessed treatment preferences. Participants were presented with pairs of hypothetical treatment scenarios and had to pick which one they would choose. The attributes compared were:

  • Route of administration: oral or injection
  • Treatment frequency: 1 monthly, 1 weekly, 2 daily or 3 daily
  • Frequency of flu-like or gastrointestinal symptoms: 2 days monthly or 7 days monthly

Each treatment scenario contained the option pill vs injection and then combinations of the other attributes were used to create 64 different scenarios.

For example one scenario asked "which treatment would you prefer":

Option A – pill, taken 3 times daily, with side effects occurring 7 days monthly

Option B – injection, taken once a week, with side effects occurring 7 days a month


What was found

Overall the study found that participants would prefer to take a pill, that did not need to be taken very often and had infrequent side effects.

Participants choices were found to be more strongly influenced by treatment frequency and how it was taken, than by the frequency of side effects. However when the results were split into two groups based on if the participant answering the question had taken a DMT before or not, it was found that the preferences of the group that had never used a DMT were more influenced by how often side effects would be experienced.

The majority of participants (93%) questioned would prefer to take a pill, when frequency of side effects and how often it needed to be taken were the same as for the injection option. However preference switched to injections, if the pill had to be taken much more often (pills taken 3 times a day vs an injection only once a week) and also when pills were associated with more frequent side effects.


What does it mean?

The study authors conclude that their study suggests that route of administration and frequency of treatment are important considerations for people with MS when choosing which type of DMT they would prefer.

The authors do state that as their questionnaire involved hypothetical scenarios, many of the situations posed to the participants do not directly correspond to a particular DMT that is available. There are also several other characteristics associated with DMTs that they did not explore, such as the risk of serious side effects and how effective and beneficial the treatment is. So although the study did not explore all of the factors that could influence a person's choice between potential treatment options, it gives some indication of how benefits and risks are weighed up.


Utz KS, Hoog J, Wentrup A, et al.
Patient preferences for disease-modifying drugs in multiple sclerosis therapy: a choice-based conjoint analysis..
Ther Adv Neurol Disord. 2014 Nov;7(6):263-75.
abstract
Read the full text of this paper

More about making decisions about disease modifying therapies

Disease modifying therapies (DMTs) work by interacting with different parts of the immune system to calm down the inflammation that causes MS relapses. DMTs are not a cure for MS and currently can only reduce the number of relapses rather than stopping them entirely. However, by reducing the number and severity of relapses, some of these drugs have also been shown to slow the build up of disability.

There are an increasing number of DMTs available for the treatment of MS. Choosing which DMT to try is a complex decision and although the neurologist and MS specialist nurse can advise on eligibility and suitability for treatments, often people with MS are faced with a choice between two or more drugs.

Ideally a decision about what treatment is right for you will be reached by considering the benefits you might expect and any potential associated risks. This includes effects on lifestyle such as when and how a course of treatment is taken. Whilst a neurologist may be an expert in MS, you are the expert in your own MS and how it affects your life; you know your own goals for the treatment and your commitment to stick to the course.

When making decisions about your healthcare and treatment, asking three key questions works well.

They are:

  1. What are my options?
  2. What are the pros and cons of each option?
  3. How do I get support to help me make a decision that is right for me?

You can read more tips for discussing disease modifying drug therapies in our recently updated publication Disease modifying drug therapy which can be read online, downloaded as a PDF file or ordered as a printed version.

We are planning a review of our online and printed resources to ensure that they are useful, accessible and support you to make the right decisions for you about starting and switching between DMTs. We would love to hear about your experiences of the deciding which DMT to try and the process you went through to when considering what was best for you. Please email your story to msdecisions@mstrust.org.uk.

Keep up to date

You can sign up to receive an email alert for the MS Trust research update. The email provides links to this page so that you can see the latest published research in MS. You can read our blog on how we choose research to include in this update.

You can also sign up for our News alerts which cover reports about MS on our news page and in the media.

Open Door, the MS Trust's free quarterly newsletter is available both by post and by email. It contains information on all the publications and support that the MS Trust provides, articles on a wide range of topics written by health professionals and people with MS as well as news about MS and recent research. Sign up for Open Door here or call us on 0800 032 38 39 or 01462 476700

Back to top


Assessment tools

Widdifield J, Ivers NM, Young J, et al.
Development and validation of an administrative data algorithm to estimate the disease burden and epidemiology of multiple sclerosis in Ontario, Canada.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Cores EV, Vanotti S, Eizaguirre B, et al.
The effect of culture on two information-processing speed tests.
Appl Neuropsychol Adult. 2014 Nov 5:1-5. [Epub ahead of print]
abstract

Back to top


Basic Research

Brill L, Goldberg L, Karni A, et al.
Increased anti-KIR4.1 antibodies in multiple sclerosis: could it be a marker of disease relapse?
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Back to top


Causes of MS

Kavak KS, Teter BE, Hagemeier J, et al.
Higher weight in adolescence and young adulthood is associated with an earlier age at multiple sclerosis onset.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Wang YJ, Li R, Yan JW, et al.
The epidemiology of alcohol consumption and multiple sclerosis: a review.
Neurol Sci. 2014 Nov 12. [Epub ahead of print]
abstract

Goulden R, Ibrahim T, Wolfson C.
Is high socioeconomic status a risk factor for multiple sclerosis? A systematic review.
Eur J Neurol. 2014 Nov 5. [Epub ahead of print]
abstract

Back to top


Diagnosis

Fallahi-Khoshknab M, Ghafari S, Nourozi K, et al.
Confronting the diagnosis of multiple sclerosis: a qualitative study of patient experiences.
J Nurs Res. 2014 Dec;22(4):275-82.
abstract

Back to top


Disease modifying treatments

Bianco A, Patanella AK, Nociti V, et al.
Second-line therapy with Fingolimod for relapsing-remitting multiple sclerosis in clinical practice: the effect of previous exposure to Natalizumab.
Eur Neurol. 2014 Nov 7;73(1-2):57-65. [Epub ahead of print]
abstract

Massacesi L, Tramacere I, Amoroso S, et al.
Azathioprine versus Beta Interferons for relapsing-remitting multiple sclerosis: a multicentre randomized non-inferiority trial.
PLoS One. 2014;9(11):e113371.
abstract

Read the full text of this paper

Tsourdi E, Gruber M, Rauner M, et al.
Graves' disease after treatment with Alemtuzumab for multiple sclerosis.
Hormones (Athens). 2014 Nov 5. [Epub ahead of print]
abstract

Read the full text of this paper

Sastre-Garriga J, Tur C, Pareto D, et al.
Brain atrophy in natalizumab-treated patients: A 3-year follow-up.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Vidal-Jordana A, Tintoré M, Tur C, et al.
Significant clinical worsening after natalizumab withdrawal: predictive factors.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Zagmutt FJ, Carroll CA.
Meta-analysis of adverse events in recent randomized clinical trials for dimethyl fumarate. Glatiramer acetate, and teriflunomide for the treatment of relapsing forms of multiple sclerosis
Int J Neurosci. 2014 Nov 11:1-23. [Epub ahead of print]
abstract

Freedman MS.
Evidence for the efficacy of interferon beta-1b in delaying the onset of clinically definite multiple sclerosis in individuals with clinically isolated syndrome.
Ther Adv Neurol Disord. 2014 Nov;7(6):279-88.
abstract

Read the full text of this paper

Chahin S, Balcer LJ, Miller DM, et al.
Vision in a phase 3 trial of Natalizumab for multiple sclerosis: relation to disability and quality of life.
J Neuroophthalmol. 2014 Nov 3. [Epub ahead of print]
abstract

Read the full text of this paper (PDF)

Fyfe I.
Multiple sclerosis: rffects of IFN-β treatment on vitamin D levels in multiple sclerosis are modified by genetic variants.
Nat Rev Neurol. 2014 Nov 4. [Epub ahead of print]
abstract

Lewis MS, McMillan GP, Hutter M, et al.
Does interferon Beta-1a impact pure-tone hearing sensitivity among individuals with multiple sclerosis?
J Neurosci Nurs. 2014 Dec;46(6):351-60.
abstract

Back to top


Paediatric MS

Rocca MA, De Meo E, Amato MP, et al.
Cognitive impairment in paediatric multiple sclerosis patients is not related to cortical lesions.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Brown RA, Narayanan S, Banwell B, et al.
Magnetization transfer ratio recovery in new lesions decreases during adolescence in pediatric-onset multiple sclerosis patients.
Neuroimage Clin. 2014;6:237-42.
abstract

Read the full text of this paper

Aubert-Broche B, Fonov V, Narayanan S, et al.
Onset of multiple sclerosis before adulthood leads to failure of age-expected brain growth.
Neurology. 2014 Nov 5. [Epub ahead of print]
abstract

Back to top


Physical activity

Cramer H, Lauche R, Azizi H, et al.
Yoga for multiple sclerosis: a systematic review and meta-analysis.
PLoS One. 2014;9(11):e112414.
abstract

Read the full text of this paper

Hansen D, Wens I, Keytsman C, et al.
Ventilatory function during exercise in multiple sclerosis and impact of training intervention: cross-sectional and randomized controlled trial.
Eur J Phys Rehabil Med. 2014 Nov 4. [Epub ahead of print]
abstract

Read the full text of this paper

Back to top


Prognosis

Paz Soldán MM, Novotna M, Abou Zeid N, et al.
Relapses and disability accumulation in progressive multiple sclerosis.
Neurology. 2014 Nov 14. [Epub ahead of print]
abstract

Uher T, Horakova D, Bergsland N, et al.
MRI correlates of disability progression in patients with CIS over 48 months.
Neuroimage Clin. 2014;6:312-9.
abstract

Read the full text of this paper

Jacobsen C, Hagemeier J, Myhr KM, et al.
Brain atrophy and disability progression in multiple sclerosis patients: a 10-year follow-up study.
J Neurol Neurosurg Psychiatry. 2014 Oct;85(10):1109-15.
abstract

Read the full text of this paper

Back to top


Provision of care

Embrey N.
Multiple sclerosis: managing a complex neurological disease.
Nurs Stand. 2014 Nov 12;29(11):49-58.
abstract

Back to top


Psychological aspects

Jones SM, Amtmann D.
The relationship of age, function, and psychological distress in multiple sclerosis.
Psychol Health Med. 2014 Nov 4:1-6. [Epub ahead of print]
abstract

Guzel Ozdemir P, Milanlioglu A, Boysan M, et al.
Relations between mood characteristics, circadian preferences, and functionality in multiple sclerosis.
Int J Psychiatry Clin Pract. 2014 Nov 3:1-22. [Epub ahead of print]
abstract

Choobforoushzadeh A, Neshat-Doost HT, Molavi H, et al.
Effect of neurofeedback training on depression and fatigue in patients with multiple sclerosis.
Appl Psychophysiol Biofeedback. 2014 Nov 2. [Epub ahead of print]
abstract

Back to top


Rehabilitation

De Giglio L, De Luca F, Prosperini L, et al.
A low-cost cognitive rehabilitation with a commercial video game improves sustained attention and executive functions in multiple sclerosis: a pilot study.
Neurorehabil Neural Repair. 2014 Nov 14. [Epub ahead of print]
abstract

Brichetto G, Piccardo E, Pedullà L, et al.
Tailored balance exercises on people with multiple sclerosis: a pilot randomized, controlled study.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Back to top


Stem cells

Snarski E, Snowden JA, Oliveira MC, et al.
Onset and outcome of pregnancy after autologous haematopoietic SCT (AHSCT) for autoimmune diseases: a retrospective study of the EBMT autoimmune diseases working party (ADWP).
Bone Marrow Transplant. 2014 Nov 10. [Epub ahead of print]
abstract

Li JF, Zhang DJ, Geng T, et al.
The potential of human umbilical cord-derived mesenchymal stem cells as a novel cellular therapy for multiple sclerosis.
Cell Transplant. 2014 Nov 5. [Epub ahead of print]
abstract

Read the full text of this paper

Back to top


Symptoms and symptom management

Finke C, Schlichting J, Papazoglou S, et al.
Altered basal ganglia functional connectivity in multiple sclerosis patients with fatigue.
Mult Scler. 2014 Nov 12. [Epub ahead of print]
abstract

Sandry J, Genova HM, Dobryakova E, et al.
Subjective cognitive fatigue in multiple sclerosis depends on task length.
Front Neurol. 2014;5:214.
abstract

Read the full text of this paper